Most people don't get any symptoms from HIV for some years after becoming infected. Some people don't get any symptoms for 20 years, even without treatment. Before you get symptoms, you should feel healthy and you should be able to do anything you would normally do.
But you'll still need to see your doctor regularly during these years. Your doctor needs to keep track of your health. And you may need to have blood tests to see if HIV is damaging your immune system. In particular, the tests will look at your CD4 count and the amount of HIV in your blood, which is also called your viral load.
The most important decision you and your doctor need to make during this time is when to start drug treatments for HIV. The drugs are called antiretroviral drugs. They help to prevent the virus from damaging your immune system. And they protect you from getting the infections that go along with HIV.
To learn more, see When to start treating HIV.
Most doctors think that it's best to start taking antiretroviral drugs when your CD4 count drops below 350. This is a measure of how many CD4 cells there are in your blood.1 The more cells you have, the healthier your immune system. However, it is also important to consider how fast your CD4 count is falling, your viral load and any symptoms of opportunistic infections. You'll also want to consider whether the time is right for you to start on a daily medicine regime.
Some doctors think it makes sense to start treating people before their CD4 count drops below 350. They say we now know how best to keep side effects to a minimum. But doctors aren't completely agreed about this.2
Taking antiretroviral drugs helps to keep your CD4 count up. This means you're less likely to get the infections and certain types of cancer that go with AIDS. Since 1996, people with HIV have been taking a combination of three or more antiretroviral drugs. Before 1996, people were treated with just one or two antiretroviral drugs and the outlook for most people is now dramatically better than it was before then.
Exactly how well the drugs will work to keep you healthy depends on several factors, including how low your CD4 count was at its lowest level and on what your viral load is. Having a low CD4 count at the time of starting treatment is less favorable. Also, people who are over 50 years old when they are diagnosed, or who contracted HIV through intravenous drug use, tend to do less well than others.3
- Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. April 2005. Available at http://aidsinfo.nih.gov/ContentFIles/AdultandAdolescentGL.pdf (accessed on 20 June 2008).
- Phillips AN, Gazzard BG, Clumeck N, et al When should antiretroviral therapy for HIV be started? British Medical Journal 2007; 334: 76-78
- Egger M, May M, Chene G, et al. Prognosis of HIV-1 infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002; 360: 119-129. 12126821
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This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved. |
