3 Introduction to anti-retrovirals (ARVs)

3.7 When to start treatment

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Firstly, before starting treatment someone has to be ready to do so. All treatment guidelines agree that it is important you are prepared to take treatment before starting.

Secondly, anyone with any HIV-related symptoms is usually recommended to start treatment (at any CD4 count).

Thirdly, everyone – with or without symptoms – is recommended to start before their CD4 count falls to below 200 cells/mm³. Some countries recommend starting at higher CD4 counts (eg before the count falls to 350 cells/mm³).

Current research is looking at risks and benefits of starting at higher CD4 counts.

Section 1: immune system and CD4 count

Being ready to start treatment

This involves understanding that:

• Treatment will help your health
• 100% adherence means taking every dose
• 100% adherence means following any food recommendations
• Side effects will usually be mild and can be managed

These 'non-medical' aspects are very important:

• Someone has to be committed to treatment before they start.
• If adherence is not good, resistance will develop and treatment will fail.