Why you should start ART right away

Antiretroviral therapy, or ART, is a safe and proven way to treat HIV. Your doctor wants you to start right away — usually the same day you’re diagnosed. This is called Quick Start ART. Early and effective treatment can help you lead a normal life. It can also make it less likely that you’ll pass the virus on to someone else.

The sooner you start ART, the better. This also applies when you are feeling well.

“There’s no point in waiting,” says Shannon Galvin, MD, associate professor of medicine and infectious diseases at Northwestern Medicine. “Anyone who has HIV will benefit from treatment, regardless of their T cell count.”

Effective ART can lower your viral load so low that blood tests can’t find it. That not only keeps you healthy. It means there is next to no chance that you will sexually transmit the virus to someone else. This is called “undetectable equals non-transferrable”. Reaching this state quickly can make you feel more in control and more hopeful about your condition, says Gregory Huhn, MD, associate professor of medicine and infectious diseases at Rush University Medical Center.

ART can help you stay healthy. But it is not a cure for HIV. You must take your medicine every day. If you have any questions about your treatment, talk to your doctor before you start. They can help you find a plan that works for you.

How does ART treat HIV?

This combination of drugs can lower the amount of HIV in your blood, called viral load. This keeps your CD4 count up. The higher this number, the more T cells you have and the better your immune system is functioning. ART also lowers your HIV-related immune activation. This is inflammation that can injure your heart, brain, bones, and other organs.

Basically, ART reduces the chance that you will get HIV. And that helps you live longer.

“If you take a 20-year-old with a CD4 above 500 who starts ART immediately after diagnosis — and they don’t have hepatitis B, C, or other comorbidities — their life expectancy is about the same as a person without HIV,” says Huhn .

Who should start ART immediately?

In the past, doctors have given people with very low CD4 levels fast-start ART. But now everyone with HIV is likely to get it. “We have hard data showing that everyone (with HIV) lives longer and healthier when they take antiretroviral drugs,” says Galvin.

ART is even more important for certain groups. This includes people who:

• Are pregnant. You are less likely to pass HIV to your baby if you have an undetectable viral load. If you are already taking ART, continue to take your medicine. But if not, talk to your doctor about how to start treatment right away.
• Have a low CD4 count. People with a CD4 count of less than 200 have a high risk of developing the disease. In fact, a CD4 count that low means you have AIDS.
• Do you have an AIDS-defining medical condition. These are infections and cancers that are particularly serious for people living with HIV.

Should anyone delay ART?

There are very few people who should wait to start ART, says Huhn. But sometimes you may need to treat certain infections first.

Your doctor may delay your ART if you:

Your doctor may also want to treat serious mental illnesses first, Huhn says. Untreated mental health or substance abuse problems can make it difficult for you to keep up with treatment.

What if you’re not ready?

It is normal to take some time to record your diagnosis. It is still considered a quick start if you start ART within 7 days. The most important thing is that you are willing to stick with the treatment once you start. “There are a few people who need to think about it, and they should be given that opportunity,” says Galvin. “We just want to make sure we’re starting something that we want to continue.”