What to Expect After Starting Treatment for HIV

  • portrait-of-serious-young-man
    Today, HIV rarely turns into AIDS.
    HIV, or human immunodeficiency virus, weakens the immune system and makes you more susceptible to infections and diseases. If untreated, HIV can eventually turn into acquired immune deficiency syndrome or AIDS, which is the end-stage, clinical syndrome of the HIV infection. Because of the improved treatment options and increased awareness since I first began my career in 1998, patients with HIV today have many reasons to be optimistic. If individuals are on effective therapy, the virus rarely escalates into AIDS, and most people who are diagnosed HIV-positive and take their medications every day can expect to live a full and normal life.   

  • medication
    You need to take your medication every day.
    If you have HIV, you have to remain on medication every day for the rest of your life. Missing just one day can cause your virus to become resistant to that specific treatment, which means you’d have to switch to a different one. Bottom line? When the virus is not fully controlled (and it won’t be if you’re not taking your medications every day), the HIV replicates extremely rapidly. During replication, new forms or “mutations” of the virus are created, and these mutations may not respond to the antiretroviral regimen you’re currently on. That means your virus will become resistant to that specific treatment for the rest of your life, forcing you to switch to another one. And though there are more treatment options for HIV than when the virus was discovered in the 1980s, the choices are not endless, and some have worse side effects than others.


  • man-sick-in-bed
    You may experience side effects.
    Your initial anti-HIV medication cocktail, as it’s sometimes called, may cause intolerable side effects like diarrhea, rashes, nausea and vomiting. There may also be psychiatric effects, such as mania, vivid nightmares, and worsening of any pre-existing mental illness, which sometimes may outweigh the benefits of the treatment. Any pre-existing conditions, or medications you are taking for those pre-existing conditions, could cause or worsen the side effects of your anti-HIV treatment. At worst, these factors can cause your virus to become resistant to the antiretroviral (ART) or anti-HIV medication, meaning the virus will begin replicating freely in your body.


  • Blood Test
    You will need to monitor your viral load.
    There are two important numbers you will need to monitor after being diagnosed with HIV. The first is your viral load, which refers to how much virus is replicating freely in your body. We want that to be at undetectable levels, so the disease is “virally suppressed” and our machines can’t detect it in the non-lymphatic, or “peripheral” blood. We know the virus is still hiding away in the lymphoid tissue, liver and spleen, which is why, at least at this time, it can’t be cured. But as long as it’s undetectable elsewhere in the blood with treatment, you’re in good shape. Next, you’ll need to monitor your Cluster of Differentiation 4 (CD4) T cell count.

  • Serious Business Man
    Your CD4 T cell count is an essential indicator.
    CD4 T cells are one of the subsets of T cells in our body that we use to fight infection. A normal CD4 T count is above 500. If it starts to drift down below 200, you increase your risk for certain serious, opportunistic infections like recurring pneumonia and some cancers. When it’s below 50, it’s considered AIDS. However, as long as you get on--and stay on–effective therapy, and your viral load remains undetectable, your HIV should never progress to AIDS. 

What to Expect After Starting Treatment for HIV

About The Author

Dr. Stacey Rizza is Chair of the Mayo HIV Clinic, and Associate Professor of Internal Medicine at the Mayo Medical School. She has been treating HIV patients since 1998.
View her Healthgrades profile >
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THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.
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