Treatment training manual

3. 7 When to start HIV treatment (ART)

Most countries recommend ART for all HIV positive people. This is at any CD4 count, even when the CD4 count is strong and above 500.

This change occured in 2015 when several important studies (including START) showed the benefits of early ART. It is also related to other studies showing that ART dramatically reduces the risk of HIV transmission.

Before starting treatment someone has to be ready to do so. All treatment guidelines state that someone needs to be prepared to take treatment before they start.

Anyone with any HIV-related symptoms usually has a greater urgency to start ART.

Everyone—with or without symptoms—is strongly recommended to start before their CD4 count falls to below 350 cells/mm3.

Being ready to start treatment involves understanding that:

  • Treatment will help your health.
  • The best adherence means taking every dose and this is linked to the best chance of treatment success.
  • Adherence means following any food recommendations.
  • Side effects will usually be mild and can be managed.

These ‘non-medical’ aspects are very important:

  • Someone has to be committed to treatment before they start.
  • If adherence is not good, resistance will develop and treatment will fail.

See Section 1.13 — Use of CD4 count to start treatment

Last updated: 1 January 2016.