You and your doctor should consider several factors in deciding when to start drug therapy. Your viral load and CD4 (T-cell) count will help determine whether you should start treatment. You also should consider how well you will be able to follow your treatment and weigh the potential benefits and risks.
Viral load is the amount of HIV in a person’s blood. High viral loads are more likely to cause a rapid progression from HIV to AIDS. Taking HIV medications as prescribed will reduce the amount of HIV in the blood. This is called viral suppression.
Viral suppression means HIV medications have lowered or suppressed your viral load to less than 200 copies of HIV or less per milliliter of blood. Some viral loads may be so low they are undetectable by viral load tests. It is important to continue to take your HIV medications as prescribed to remain virally suppressed. You should continue to practice safer sex and/or risk reducing behaviors and continue to see your doctor on a regular basis to ensure your viral load remains low or suppressed.
You still have HIV, but HIV medications have lowered the amount of the virus in your blood so much that the test used to measure the viral load could not detect it. It is important to continue to take your HIV medications as prescribed to remain undetectable. You should continue to practice safer sex and/or risk reducing behaviors. You should also continue to see your doctor on a regular basis to ensure your viral load stays undetectable.
No. Undetectable equals Untransmittable or U=U.
According to the CDC, people who take their HIV medications consistently and as prescribed, and get and keep an undetectable viral load (or stay virally suppressed) have effectively no risk of transmitting HIV to their HIV-negative sexual partners. It is important to continue to take your medications as prescribed to maintain viral suppression or undetectable viral load.
You should continue to practice safer sex and/or risk reducing behaviors for the prevention of other STIs.
A CD4 (T-cell) count is a measurement of a person’s CD4 (T-cells.) T-cells are a type of white blood cell that help the body fight off infection. HIV attacks a person’s CD4 (T-cells) and uses them to replicate (make copies of itself). As these cells are destroyed, the person’s immune system is weakened and has a harder time fighting off infections, some of which may be life threatening.
My doctor and I have decided not to treat my HIV infection. Do I need to have my CD4 T-cell count tested again?
Yes. People living with HIV who have not started drug therapy should have a viral load test every 3-4 months and a CD4 (T-cell) count every 3-6 months. Talk to your doctor about when you should be tested again.
In general, your viral load is the most important factor in determining whether your medications are working. Other important factors are your CD4 (T-cell) count, your recent clinical history, and findings from a physical examination by your doctor. Your viral load should be tested again 2-4 weeks after you start treatment. If your drugs are working, your viral load should be decreasing, and it should continue to decrease as you continue to take your medications.
Throughout HIV treatment, your viral load should be tested every 3-4 months to make sure your drugs are still working. If your viral load has not decreased within 4-6 months after starting treatment, you should talk to your doctor about possibly changing your medications.
How fast or how much your viral load decreases may depend on other factors, not only on the drugs you are taking. These factors can include your baseline viral load (viral load before starting medication) and CD4 (T-cell) count (count before starting medication), whether you have used Antiretroviral drugs before, whether you have any opportunistic infections or illnesses, the stage of your HIV when you begin your medication, and how closely you have followed your medication regimen. Talk to your doctor if you are concerned about your viral load not decreasing. CD4 (T-cell) counts also may help show how well your medications are working. After starting drug therapy, your CD4 (T-cell) count should be tested every 3-6 months. Talk to your doctor if you are concerned about your CD4 (T-cell) count.
HIV treatment is the use of Antiretroviral drugs to decrease a patient’s viral load. In most people who start HIV treatment (Antiretroviral therapy), the viral load drops to undetectable levels within 6 months. However, Antiretroviral therapy is complex, and different people may have different results so you should work with your doctor to find a treatment regimen that works for you. Antiretroviral therapy has also been shown to benefit people with advanced HIV and weakened immune systems.
Yes. Adherence means you take your medicine(s) every day and exactly as prescribed by your doctor. Adherence is very important because skipping doses or stopping your medication will allow the amount of HIV in your blood (viral load) to increase quickly. This can affect how well your medicine works by causing drug resistance, which may leave you with fewer treatment options. Increased viral load due to stopping or skipping medication doses will also heighten the risk of transmitting HIV to others and cause your health to decline due to an increased amount of HIV in your blood. It will also quicken the progression of HIV to AIDS. If medicines are taken as prescribed, HIV may never progress to AIDS.
Other factors that may affect how well your medicine works include your baseline viral load (viral load before beginning medications) and CD4 (T-cell) count (count before beginning medications), whether you have used antiretroviral drugs before, if you have any opportunistic infections or illnesses and the stage of your HIV when you begin your medication.
Tell your doctor if you are having any problems related to your medication, including side effects. If you are experiencing side effects, tell your doctor what they are, and when you notice them. Your doctor needs this information to help you get the best result from your treatment plan and provide options, if necessary.
Skipped doses: Do not be afraid to admit to skipped doses. Your doctor knows that some people do have difficulty taking each dose as prescribed. If you have skipped doses, tell your doctor which medication(s) you skipped, and when.
Difficulty taking your medication as prescribed: If you are supposed to take medication on an empty stomach or with food, and this is difficult for you, tell your doctor. If there is a time of day that is too difficult for you to take your dose, tell your doctor this, too.
Your treatment regimen interferes with your lifestyle: If you feel your treatment regimen is too complicated or unrealistic for you to follow, talk to your doctor about other options you may have.
There are two possible reasons for this. One possible reason could be if you are having side effects which make it difficult to take the drugs as prescribed. Another possible reason is your viral load is not decreasing which means the drug is not working for you. You should ask your doctor to explain why the change is needed in your treatment.
If the reason is your negative side effects, your doctor may change the drug(s) causing the problem. In this case, your doctor may substitute drugs with different ones of the same potency and class.
If the reason for changing your medications is because the drug is not reducing your viral load, your doctor should change all your drugs to new ones you have never taken, if possible. If you have been taking three drugs, and all three drugs cannot be changed, then at least two drugs should be changed. This is very important to reduce the risk of developing drug resistance.
Before changing your medications, you should talk to your doctor about:
- All the antiretroviral medications you have taken before
- The potency of the new drugs your doctor recommends
- Possible side effects of the new drugs
- How well you will be able to follow the new treatment
- The number of antiretroviral drugs remaining that you have not yet used
If you have no treatment options for approved drugs, you may be able to participate in a clinical trial using drugs that are being studied. For more information, ask your doctor or go to https://clinicaltrials.gov to search for an HIV/AIDS clinical trial seeking volunteers. Call a health information specialist at 1-800-448-0440 (1 p.m. to 4 p.m. EST) for help with your search. You may also email ContactUs@HIVinfo.NIH.gov.