If you’re one of the nearly 40,000 people in the U.S. who are diagnosed with HIV each year, you’ll want to start treatment right away. Even if you feel fine, early drug treatment -- as soon as the same day as your diagnosis -- gives you the best chance to stay healthy and to keep from passing the virus to others.
How Your Treatment Works
It’s called antiretroviral therapy (ART). The drugs help keep your body’s virus count, called an HIV “viral load,” low or “undetectable.” That in turn lets your immune system heal itself and stay strong. It also lowers the odds that you might spread HIV to other people.
ART starts to work quickly, within hours and days. But you need to take your medicine every day as directed. If you stop, the virus will multiply and make you sick. You’re also more likely to infect others. Skipping your meds also may lead to drug resistance, which will make the medication work less and less well when you go back on it.
How to Prepare
Before you start ART, you’ll have blood tests and a physical exam to rule out other infections or diseases that also need to be treated. Your doctor may also want to check that your virus isn’t resistant to any of the current HIV drugs.
You’ll take at least three antiretroviral drugs. Sometimes, they are all in one pill. The most common combinations for people newly diagnosed with HIV include:
- Two nucleoside (or nucleotide) reverse transcriptase inhibitors (“NRTIs”), such as abacavir, emtricitabine, lamivudine, and tenofovir
- A third drug from a different class, such as integrase strand inhibitors (“INSTIs”) -- bictegravir, dolutegravir, elvitegravir, or raltegravir
Treatment Questions
HIV drugs can be taken in many different combinations. You and your doctor will find the therapy that works best for you. You'll want to think about:
Number of pills. Most people start with one to two pills a day. If you have trouble remembering to take your doses, ask if combination drugs can cut down the number of daily pills.
Insurance. You’ll stay on your HIV drugs for the rest of your life. Make sure your specific medication is covered by insurance, with affordable co-pays. If not, ask your doctor if it’s possible to switch to different drugs.
Pregnancy. Tell your doctor if you are or could be pregnant, or if you plan to have children later. Some HIV drugs aren’t safe for unborn babies.
Side Effects
If your HIV drugs cause problems, your doctor can prescribe medicine to ease the side effects or switch you to different HIV drugs.
Monitoring
Your doctor will check your blood every 3-6 months to keep tabs on your HIV and how well your treatment is working. The main tests are:
Viral load. This is the gold standard for tracking your HIV treatment. It’s the amount of HIV in your blood. The goal of your treatment is to make it so low that it’s undetectable. That means you have too few viruses for tests to pick up, and that you can’t pass on HIV to someone else.
Most people reach undetectable levels within 3 months of starting their HIV medicines. After that, your doctor will check your viral load every 3 to 6 months for the rest of your life. If your doctor changes your HIV drugs, you’ll probably get a viral load test about a month later, and then every 3-6 months.
CD4 Cell Count
Also called T-cells, these help your body fight infections. HIV attacks these cells, and makes it easier for you to pick up infections and get sick. Your doctor will check your CD4 count every 3-6 months if it’s in the low range (less than 500 cells per cubic millimeter of blood). If your CD4 count is higher and your HIV viral load is undetectable, you may not need routine testing for CD4.
Your doctor may use the results from these two tests to adjust your dosage or change your medication.
Self-Care
Medication can help keep your HIV in check. But your personal actions also will have a big effect on your health.
Always use a condom. Even if your viral load is undetectable, it’s best to use a condom for backup protection when you have sex. Condoms are the best way to prevent not only HIV, but other sexually transmitted diseases like herpes, chlamydia, gonorrhea, and syphilis.
Eat healthy foods. You may need more calories when you have HIV because your body has to fight harder to keep infections away. Pick proteins like lean meat, fish, beans, and nuts, healthy fats like avocado, whole grains, fresh fruit, and lots of veggies. Drink plenty of water.
Exercise (almost) every day. Aim to walk, bike, swim, or do another moderate workout for 30 minutes 5 days a week. Lifting weights or doing another resistance exercise can help make up for muscle loss from HIV.
Quit smoking. Tobacco is bad for your health, and even more so if you’re HIV-positive. Smoking, vaping, or chewing tobacco will make you more likely to get problems like chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, asthma, and heart disease.
Cut down on alcohol and other recreational drugs. HIV is very hard on your body. So you may take longer to recover from the effects of drinking or using marijuana or other drugs. Using these drugs a lot may also impair your ability to take your medicines regularly and your judgment regarding high-risk behaviors.