“The daily onslaught of virus replication causes the immune system to work overtime to suppress it,” says Michael Saag, MD, the director of the University of Alabama at Birmingham Center for AIDS Research. This wears down your immune system and contributes to systemic inflammation, putting you at risk for other health issues. If that’s the case, Dr. Saag says, “Why wait to start treatment?” Physicians track the impact of HIV on the immune system by measuring levels of CD4 cells (also called T-helper or T-4 cells) — the infection-fighting white blood cells that HIV attacks. As HIV progresses, CD4 counts drop; when the number dips below 200 (meaning fewer than 200 CD4 cells per cubic millimeter of blood) the diagnosis is AIDS. In the New England Journal of Medicine investigation — a three-year study known as the START trial that followed more than 4,600 people with HIV in 35 countries — researchers found that starting antiretroviral therapy when the CD4 count was above 500 resulted in fewer complications and deaths than waiting until the count dipped below 350.
Why Treatment Is Recommended for Everyone With HIV
According to AIDSinfo, a service of the U.S. Department of Health and Human Services, anyone infected with HIV should begin antiretroviral therapy as soon as possible. But first you’ll need testing to confirm an HIV-positive diagnosis — the sooner, the better. “If we could get those who have HIV into care early on and get their viral load suppressed, we could make a dent in the HIV/AIDS epidemic,” says Veronica Ayala-Sims, MD, a former clinical director of the Virginia Commonwealth University HIV/AIDS Center in Richmond. Here are five important reasons to start treating the virus early.
1. You’ll stay healthier longer.
Your CD4 count goes up once you start antiretroviral therapy, according to the START trial results. The findings show that starting treatment early means fewer serious AIDS-related and non-AIDS-related health complications. “If you wait to start treatment, you will likely have more problems than if you don’t wait,” says Michael Kolber, MD, PhD, the director of the Comprehensive AIDS Program at the University of Miami Miller School of Medicine in Florida. “HIV is a virus that preys upon your inability to take care of yourself.”
2. You’ll lower your risk for certain HIV-related cancers.
People with HIV are at increased risk for cancers like lymphoma and Kaposi’s sarcoma, according to the START trial. But the study found that people with HIV who started treatment with antiretroviral therapy earlier rather than later reduced their risk for Kaposi’s sarcoma.
3. You’ll lower your chances of developing opportunistic infections.
A healthy immune system can fight off many viruses and other harmful pathogens. But people with HIV have a weakened immune system that leaves them vulnerable to certain opportunistic infections, like thrush. There are more than 20 types of opportunistic infections, and developing one means you’ve transitioned to an AIDS diagnosis. Antiretroviral therapy can raise your CD4 count to help your immune system fight these infections, according to the U.S. Department of Health and Human Services.
4. You can reduce the odds of transmitting HIV to someone else.
When medication suppresses your viral load, you’re not as likely to transmit HIV to others, according to a study published in July 2016 in the Journal of the American Medical Association. Over an average of two years, the researchers followed more than 1,100 couples in which one partner had HIV; the couples did not use condoms. Findings show that the HIV-positive subjects with suppressed viral loads did not transmit the virus to their partner. “Treatment is prevention” when it comes to HIV, Dr. Ayala-Sims says, but this doesn’t mean condoms don’t play a vital role in preventing the spread of other sexually transmitted diseases: “We still see transmission of gonorrhea, syphilis, chlamydia, and hepatitis C.”
5. You’ll get access to other services.
Once you’ve started HIV treatment, your clinic can also help you connect with other services you may need, including social services, addiction recovery, and mental-health counseling, Dr. Kolber says. Talk with your medical team about any difficulties in your life that are making it hard to start or stick with HIV treatment.
