 
Time to Treat?
by Kellee Terrell
Knowing when to start or switch treatment—and which meds to use—is critical to your HIV care.
Taking medicine can halt the damage HIV does to your immune system, ultimately helping you live longer and healthier. But when it comes to treatment, there are many questions: When do you start? Which meds do you use? Will you ever need to switch?
In terms of deciding if and when to start treatment, there is no one right or wrong answer—it’s different for each person. “Some patients think that if they look and feel healthy, they don’t have to be on meds, which is not necessarily true,” states Smith. Starting meds, she says, depends on a number of things, including the number of CD4 cells (CD4 count) and amount of virus (viral load) in your blood. “If you’re tired a lot and have conditions like skin rashes, recurrent yeast infections and chronic diarrhea, regardless of your CD4 count, I am definitely going to suggest starting HIV treatment,” says Smith.
Beyond viral load and CD4 counts are other lab tests that can help you make informed treatment decisions. For example, there’s a test available to help you and your doc determine if you’re at risk for a severe allergic reaction to abacavir—found in Ziagen and Epzicom—and should avoid the drug. Lab tests can also be used to monitor your health while you’re on HIV meds with certain side effects, such as those known to increase artery-clogging cholesterol levels or cause damage to organs like the liver or kidneys.
If, once you have started treatment, your viral load does remain undetectable, your CD4 count continues to fall or you find that the side effects are unmanageable, switching to a new regimen might be necessary. And just as there are different med options for those starting ARVs for the first time, there are also options for those needing to switch.
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