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How HIV treatment works

Antiretroviral treatment (ART) means taking antiretroviral drugs (also called antiretrovirals or ARVs) to keep HIV at very low levels in your body. It protects your immune system so that you can stay healthy and live a long life.  

People with HIV should start treatment straight away. But some people may need time to process their diagnosis before they feel ready.  

There are lots of different antiretroviral drug combinations. Your healthcare worker will help you find the right one for you.  

What is antiretroviral treatment? 

Antiretroviral treatment is also known as antiretroviral therapy or ART. It is the medication that treats HIV. It involves taking antiretroviral drugs (ARVs). Treatment is not a cure for HIV – it does not remove HIV from your body completely. But it does keep HIV at very low levels so it doesn’t affect your health.  

How does antiretroviral treatment work?

HIV attacks the immune system - the part of your body that protects you from other infections. ART stops HIV from making copies of itself. This keeps the amount of virus in your body low, protecting your immune system so you’re less likely to get sick.  

When should I start antiretroviral treatment?

You should start antiretroviral treatment as soon as you are diagnosed with HIV. This is because the sooner you start treatment, the sooner it will start working. It will protect your immune system and give you the best chance of staying strong and healthy in the future.  

How long do I have to take antiretroviral treatment for?

ARVs are a lifelong medicine, so you must take them every day of your life. It is really important that you don’t stop taking them as this will affect your health. 

Can I take antiretroviral treatment if I’m pregnant or breastfeeding?

Yes, it's important that you start treatment straight away. This is because ART prevents HIV from being passed on to your baby. ART is safe to take during pregnancy and breastfeeding and will keep you and your baby healthy.  

Which antiretroviral drugs are best for me?

HIV treatment is three or more antiretroviral drugs normally combined into one pill. The World Health Organization recommends that everyone takes HIV drugs with dolutegravir (DTG). Your healthcare worker will help you to find the right treatment for you.  

How should I take my antiretroviral treatment?

Most antiretroviral drugs are taken once a day, but others are taken twice a day. There will be instructions about whether you should take them with or without food. Once you start ART it’s very important that you take it properly and don’t miss or skip doses. If you do, this can lead to HIV drug resistance which is when your drugs don’t work as well.  

Adherence

How will I know if my treatment is working?

Your healthcare worker will measure your viral load (the amount of HIV in your blood) and/or CD4 count (the strength of your immune system) at regular appointments. This shows if your treatment is working. If your viral load is still high, or your CD4 count is still low, six months after starting treatment, you may have to switch drugs. See the ‘In detail’ tab for more information. 

Undetectable

How long will I live on HIV treatment?

With good healthcare and treatment, people with HIV can expect to live as long as people who don’t have HIV.  

How do I get access to HIV treatment?

Your healthcare provider will help you work through any formalities like completing forms and getting a prescription. You can then collect your ARVs from a pharmacy. You will be given enough ARVs for a certain amount of time and then you will need to return and collect more of your pills. 

Is HIV treatment free?

This depends on where you live. Ask your healthcare provider if you can get HIV treatment for free in your country.  

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What’s the difference between viral load and CD4 count?

Viral load 

Your viral load is how much of the HIV virus is in your blood. The aim of HIV treatment is to lower your viral load and then to keep it as low as possible. WHO recommends that you have a viral load test at 6 and 12 months after you start taking treatment, and then once a year. If treatment is started early enough and followed correctly, your viral load can become undetectable within six months. This is when your viral load is less than 200 copies/ml which shows that your treatment is working very well. 

In some countries, viral load testing is not available. If this is the case where you are, your healthcare professional will monitor your health in other ways. 

CD4 count 

Your CD4 count shows the strength of your immune system. CD4 cells, an important part of your immune system, are attacked by the HIV virus. When you start taking treatment the number of CD4 cells you have (your CD4 count) will go up. A CD4 count over 500 is a sign that your immune system is recovered. If you were feeling ill because of HIV, you should start to feel better.  

Undetectable

What if I am diagnosed late and start treatment late?

If you find out you have HIV a long time after you got it, you may already have a low CD4 count (below 350). This means that your immune system is already poorly and you’re more vulnerable to infections. Starting ART immediately will protect you from getting ill and over time your CD4 count will go up again.  

Some people may find out they have HIV after they have already got an opportunistic infection. These are illnesses that people with HIV are more likely to get if their immune system is weak. In these cases, they may treat the opportunistic infection first, before you start ART.  

How quickly will my HIV treatment start to work?

Antiretroviral treatment starts to work from the first dose you take. Your viral load drops quickly in the first week of starting ART, with some people reducing their viral load by 90% in the first 7 days. With good adherence, your viral load should continue to fall steadily from this point on. Over time, as your viral load becomes lower, the speed at which your viral load drops will slow down. With proper adherence, many people will achieve a suppressed viral load within six months. 
  
How quickly your viral load drops can depend on other health factors, for example, if you have other infections at the same time. To achieve the best results, take your antiretroviral treatment as prescribed by your healthcare worker. 

What is first-line / second-line / third-line treatment?

First-line treatment is the first combination of ARV drugs that you take. If these drugs don't reduce your viral load, you can take second-line treatment. This is a different combination of drugs. If this regimen isn’t working, you can take third-line treatment.  

Is there an injectable antiretroviral treatment for HIV?

Injectables provide medication in injection rather than tablet form. The medication stays in the body longer so people can get an injection less often than taking pills.  

A long-acting antiretroviral (ARV) injectable, which only needs to be injected every one to two months, has been approved for use (or will soon be approved) in the European Union, the United States, Canada and the United Kingdom.  

Trials of injectable ARVs have begun in other parts of the world, but it will still be some time before injectable ARVs are widely available outside of these trails. 

In Africa, a trial that will involve around 500 people began in Uganda in October 2021. Kenya and South Africa are expected to join the trial by the end of 2022.  

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