Benefits and risks of early antiretroviral therapy for HIV

Early antiretroviral therapy may offer benefits to people with HIV who have a CD4+ cell count greater than 350 and do not have symptoms.1, 2 You should not start antiretroviral therapy until you have considered the following benefits and risks and discussed all the issues with your doctor.

Benefits and risks of antiretroviral therapy for HIV
Type of therapy

Early therapy: Treatment with antiretroviral medicines before CD4+ cell count drops below 350 or before HIV-related symptoms develop

Delayed therapy: Treatment with antiretroviral medicines after CD4+ cell count drops below 350 or after HIV-related symptoms develop

Benefits
  • Increases ability to achieve and maintain control of viral replication
  • Delays or prevents immune system compromise
  • Slows progression of HIV to AIDS
  • Lowers risk of resistance to the medicines, if viral suppression is complete
  • Possibly reduces risk of HIV transmission. Even with early therapy, the risk of HIV transmission still exists. Antiretroviral therapy cannot substitute for primary HIV prevention measures, such as condom use and safer sex practices.
  • Avoids negative effects on quality of life, such as the cost of the medicine
  • Avoids serious problems related to the medicines
  • Delays development of resistance to the medicines
  • Preserves the maximum number of medicine options when HIV disease risk is highest
Risks
  • Medicine-related side effects that may reduce your quality of life
  • Earlier development of resistance to the medicines if viral suppression is not complete
  • Limitation of future antiretroviral treatment options
  • Possible risks of starting antiretroviral therapy before HIV-related symptoms develop
  • Irreversible damage to the immune system, which might have been avoided by earlier treatment
  • Greater chance of getting sick
  • Greater difficulty in preventing the virus from multiplying
  • Possible increase in the risk of HIV transmission
  • Increase in the risk of death from an AIDS-related illness

Citations

  1. U.S. Department of Health and Human Services (2008). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
  2. Hammer, Scott M, et al. (2008). Antiretroviral treatment of adult HIV infection: 2008 recommendations of the International AIDS Society USA Panel. JAMA, 300 (5): 555–570.

Last Updated: April 10, 2009

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