When should I start treatment?

When should I start treatment?

This is a highly personal decision, and your doctor and you need to make it together.

Many doctors advise starting treatment with “cocktail” drugs when counts of CD4 cells (one type of white blood cell in your immune system) fall below a certain threshold. Some doctors set the threshold at 350 cell per cc. of blood, others like to start treatment when the count falls below 500.

Other doctors urge their patients to start treatment as soon as they are diagnosed, even if their CD4 cell counts are still in the normal range (800-1200 per cc.). Even during the long period between infection and first major symptoms, HIV is at work disabling your immune system and causing inflammatory disorders, so there is a good argument for hitting the virus as hard and as early as possible.

The argument against starting treatment immediately is that the drugs themselves can have side effects. Early “cocktail” drugs were rough on the system, and many doctors decided it was better to postpone using them until CD4 counts showed that the virus was doing real damage. There are many more drugs available now, and many of them are significantly kinder to your body. If your doctor knows what she or he is doing (one more reason to choose the right doctor!), you may be able to find a combination of drugs that controls the virus completely with few side effects or none at all.

If you are in a relationship with an HIV-negative partner, you have another reason to consider starting treatment immediately. When the drugs keep the virus from reproducing, there is virtually no live virus in your blood and other body fluids. It is the live virus that can infect others. If you are taking your drug “cocktail” faithfully and have no detectable live virus in your blood, it is not impossible for you to infect your partner, but it is much less likely to happen.