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Starting HIV Treatment

Over the past thirty years, both the effectiveness and tolerability of HIV medications have improved significantly. People who adhere to their treatment regimens are able to live long and healthy lives. Those newly diagnosed with HIV are often able to take as little as one pill per day, with many newer medications presenting minimal side effects. And fortunately, for those of us who live in Alberta, HIV medication (or antiretroviral therapy) is free for those living with HIV. Because of this, for most guys diagnosed with HIV in Edmonton, the question is less about accessing treatment and more about when to start.

Over the years, guidance regarding when to start meds has changed. Up until recently, most guidelines recommended waiting until someone’s CD4+ count dropped below a certain number (most recently 500). Now, however, there is a clear consensus amongst the medical community that nearly all adults living with HIV should start treatment regardless of their CD4+ count-in other words, immediately. Some of the reasons for this shift toward immediate treatment are as follows:

1. START Study

This study involved people living with HIV, all with initial CD4+ counts of greater than 500. The study split the participants into two groups of approximately equal numbers: the first group would start HIV treatment immediately and the second group would wait until their CD4+ count dropped below 350 or until they developed a serious illness.

After three years of monitoring they found a startling contrast between the two groups in terms of how many individuals experienced a serious illness or death: 42 amongst the group who initiated early HIV treatment in comparison to 96 amongst the group who deferred treatment.

2. General Inflammation

When your body is faced with an infection, it’s natural that your immune cells would enter a heightened state of activation, triggering inflammation. This short-term inflammation might take the form of a fever or a sore throat. When someone has HIV, their immune system can remain activated, leading to a chronic state of inflammation. Chronic inflammation in people living with HIV has been linked to increased risk of serious health conditions such as cardiovascular disease. Although HIV treatment does not entirely rid the body of chronic inflammation, it can decrease it and, therefore, its negative health impacts as well.

3. TasP (Treatment as Prevention)

We now know that when people living with HIV are on treatment and adhering to their medication regimen, they will often attain an undetectable viral load. When someone’s viral load is undetectable, it dramatically decreases the risk of transmitting HIV to another person. For more information, see our HIV prevention section (link).

Although medical evidence and opinion all seem to be pointing toward early HIV treatment, we must remember that not everyone feels comfortable starting new medication, especially when they may have to take that medication throughout the rest of their life. Even with medical guidance, some poz guys don’t start meds right away for reasons ranging from doubts about medicine and science to concerns about well-being and fears of change and disclosure.

The EMHC supports the consensus that early initiation of HIV treatment is generally the best option for the long-term health outcomes of poz guys. That said, the bottom line is that the decision to start meds should always rest with the individual who is living with HIV, in consultation with a qualified medical professional. HIV positive people are autonomous individuals in control of their own bodies and should not be pressured into making decisions they’re not comfortable making.

If you have concerns about starting medication you should speak with your HIV Specialist or one of the psychologists offered by the Northern Alberta Program (Edmonton’s HIV program). You can also speak with Brook at HIV Edmonton: brook.b@hivedmonton.com