HIV: Should I start taking antiretroviral medicines for HIV infection?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the facts

Your options

Start antiretroviral medicines before your CD4+ cell count is below 350 or you have symptoms of HIV or AIDS.
Don't start medicines until your CD4+ cell count is below 350 or you have symptoms. Have regular blood tests to check your levels of HIV and your CD4+ cell count.

Key points to remember

When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can help keep your immune system healthy and help you live longer.
You may need to take antiretroviral medicines even if you don't have symptoms of HIV. Experts recommend starting treatment if you have low levels of CD4+ cells, are pregnant, or you have or are at risk for other health problems.
You may not need to start treatment right away if your CD4+ count is at a healthy level.
You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
These medicines can have serious side effects. Some people are not bothered by the side effects. Other people stop taking their medicines because they feel too sick to take them.
If you're pregnant, medicines can help keep your unborn baby from getting HIV.
Whether or not you start treatment, you'll need to have blood tests every few months to check your levels of HIV and your CD4+ cell count.

FAQs

What is HIV?

HIV stands for human immunodeficiency virus. Most people get HIV when they have unprotected sex or share needles with someone who has the virus.

The virus attacks and weakens your immune system, which is your body's natural defense against infection. HIV infects certain white blood cells called CD4+ cells. If too many of these cells are destroyed or weakened, your immune system is less able to fight infection and disease.

HIV infection can lead to AIDS (acquired immunodeficiency syndrome). People with AIDS have a low number of CD4+ cells and get infections and some cancers that rarely occur in healthy people. These can be deadly.

If HIV is diagnosed before it becomes AIDS, medicines can help keep your immune system strong and healthy. With treatment, many people with HIV are able to live long and active lives.

What medicines are used to treat HIV?

A combination of three or more antiretroviral medicines, called highly active antiretroviral therapy (HAART), is the main treatment for HIV. It can slow the rate at which the virus multiplies, prevent AIDS, and keep your immune system much healthier than if you used just one kind of medicine.

The goal of treatment is to reduce the amount of virus in your body so that it can no longer be found in your blood.

There are several medicines that are most often combined to treat HIV. They are sorted into five groups:

Nucleoside/nucleotide reverse transcriptase inhibitors, such as tenofovir, emtricitabine, lamivudine, and abacavir
Nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz, nevirapine, and etravirine
Protease inhibitors (PIs), such as atazanavir, saquinavir, ritonavir, indinavir, nelfinavir, fosamprenavir, lopinavir/ritonavir, tipranavir, and darunavir
Fusion and entry inhibitors, such as enfuvirtide and maraviroc
Integrase inhibitors, such as raltegravir

You can now get some of these medicines combined into one pill. So you may only have to take one or two pills a day.

Experts recommend starting treatment if you have low levels of CD4+ cells (lower than 350), are pregnant, or you have or are at risk for other health problems. Medicines can help stabilize and increase the number of CD4+ cells in your body. And they can prevent AIDS.

How well do these medicines work?

HAART doesn't cure HIV. But people who take these medicines as prescribed:

Avoid getting AIDS, or recover from the symptoms of AIDS and enjoy a return to better health.
Have fewer infections that are common in people whose immune systems are weak, such as pneumonia and certain types of cancers. These are called opportunistic infections.
See a major drop in the amount of virus in their body, often to a level where it can no longer be found in their blood.
Have a stable or slowly increasing CD4+ cell count.

For the medicine to work, you need to take it every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.

What are the side effects of antiretroviral medicines?

Antiretroviral medicines can have serious side effects. Some people stop taking their medicines because they feel too sick to take them. But it's important that you continue to take them, because these medicines can help keep the virus under control and keep your immune system healthy.

If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.

Some side effects, such as nausea, may improve when your body adjusts to the medicines. If you have problems taking your medicines, talk with your doctor. There are medicines you can take to treat the side effects.

Side effects of some antiretroviral medicines may include:

Nausea and vomiting.
Diarrhea.
Fever.
Fatigue.
Headache.
Dizziness.
Belly pain.
Trouble sleeping.

Certain antiretroviral medicines may also cause more serious medical problems, such as a buildup of acid in your blood, and changes in the way your body stores fat and uses sugar.

Why might your doctor recommend starting antiretroviral medicines?

Your doctor might recommend that you start treatment:^1, ²

Before your CD4+ cell count drops below 350 cells per microliter.
If your CD4+ cell count is more than 350 cells per microliter and you have or are at risk for other health problems.
If you're pregnant. Medicines can help keep your unborn baby from getting HIV.
If you have symptoms of HIV or AIDS, no matter what your CD4+ cell count is.
If you also have hepatitis B, which is a virus that attacks the liver.

2. Compare your options

	Start antiretroviral medicines	Don't start antiretroviral medicines
What is usually involved?	You take pills every day. You have blood tests every few months to check your levels of HIV and your CD4+ cell count.	You have blood tests every few months to check your levels of HIV and your CD4+ cell count.
What are the benefits?	Antiretroviral medicines can: Prevent AIDS. Make your symptoms less severe. Keep your immune system healthy and prevent serious infections and some types of cancers. Reduce your chance of spreading HIV to others. Extend your life.	You don't have to take pills every day. You avoid the side effects and cost of the medicines.
What are the risks and side effects?	Possible side effects include: Nausea and vomiting. Diarrhea. Fever. Fatigue. Headache. Dizziness. Belly pain. Trouble sleeping. More serious problems may include a buildup of acid in your blood and changes in the way your body stores fat and uses sugar. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat. The medicines cost a lot.	If HIV is not treated early, you may be more likely to: Spread HIV to others. Get serious infections, some types of cancers, and AIDS. And you may die from these diseases sooner.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Human Immunodeficiency Virus (HIV) Infection.

Personal stories about starting antiretroviral medicine

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

" My cell counts and viral load are still better than the ranges where most doctors would offer me treatment. I'm still worried about taking medicine every day, but these medicines sound like my best hope of living so I can see my daughter grow up and get married. "

— Marla, age 30

" I put off taking medicine for HIV for as long as I could, but when my CD4+ cell count dropped to 350, I decided that it was time to start. The medicines made me feel dizzy and sick at the beginning, but they are helping my immune system get stronger. I am feeling a little better every week. "

— Ted, age 45

"I know several people who were feeling just fine but started HAART and got really sick. Right now, even though my cell counts are getting close to the "treatment" ranges, I'm not ready to start taking medicines. I haven't ruled out taking them later on, but for now I'm going to do the best I can to stay healthy and appreciate every day that I'm not sick. "

— Greg, age 38

"The past few years have been a really exciting time for people with HIV infection. I've followed the research pretty closely, and it sounds like every few months we know a little bit more about how best to fight this disease. I know that the newer medicines have fewer side effects than the older medicines, and people are getting treated earlier and earlier. I'm hoping that the medicines will get even better by the time my numbers get into the recommended treatment range. In the meantime, I'm going to take very good care of myself, eat well, exercise, and try to avoid infections. "

— Miguel, age 40

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take antiretroviral medicines

Reasons not to take antiretroviral medicines

I want to do everything I can to avoid getting AIDS and to live a long and healthy life.

I don't want to start taking medicine until I have to.

More important

Equally important

More important

I'm worried that I might spread HIV to others if I don't treat the infection.

I'm not worried about spreading HIV to others.

More important

Equally important

More important

I'm not worried about the side effects of treatment.

I don't think I could handle the side effects of treatment.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking antiretroviral medicines

NOT taking antiretroviral medicines

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Even though I don't have symptoms of HIV, I may still need to take medicine.

True
False
I'm not sure

That's right. Experts recommend starting treatment if you have low levels of CD4+ cells, are pregnant, or you have or are at risk for other health problems.

2. Antiretroviral medicines can help me stay healthy and prevent AIDS.

True
False
I'm not sure

That's right. When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can keep your immune system healthy and help you live longer.

3. For the medicine to work, I need to take medicine every day.

True
False
I'm not sure

That's right. You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

U.S. Department of Health and Human Services (2008). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
Hammer, Scott M, et al. (2008). Antiretroviral treatment of adult HIV infection: 2008 recommendations of the International AIDS Society USA Panel. JAMA, 300 (5): 555–570.