When Should You Start ARV Treatment? 

Anti-retroviral treatment (ARV treatment) is freely available across South Africa, and provided to all people living with HIV, through both the public healthcare sector and private healthcare sector. Cindy Pivacic shares her story of living with HIV and Anti-retroviral treatment. 

ARV treatment in South Africa

In the early days, South Africa started the free rollout of ARV treatment in April 2004. In my case, diagnosed in 2004, ARVs were only administered to me in 2008. At that time, government recommendations outlined that ARV treatment was not initiated until people living with HIV were recorded as having a CD4 count below 200. 

Your CD4 count
Years later, government recommendations were revised, to enable people living with HIV who recorded a CD4 count of 350 or lower, to initiate ARV treatment. These recommendations were then again revised to accommodate for people living with HIV who recorded a CD4 count of 500 or below. Normal levels of a CD4 cell count indicate the health of your immune system. The levels of a person who is HIV-negative can be anything between 500 and 1500. 

When to start ARV treatment

Currently, South Africa has implemented guidelines that provide insight into how and when treatment gets supplied, declaring who is eligible. Nowadays, all people, regardless of age, CD4 cell count and clinical stage, ARV treatment should be initiated within seven days unless there is a reason to defer. Same day initiation is encouraged if the client is clinically well and motivated. According to the Western Cape Department of Health (DoH), you should start taking HIV treatment immediately on diagnosis, and at the very least, within seven days, circumstances permitting.

Advantages of taking ARV treatment

The primary objective of ARV treatment is to reduce your viral load. Your viral load is a measure of how much HIV is present in your bloodstream. Once your viral load is undetectable, you cannot pass on HIV to partners. Antiretroviral therapy keeps HIV from making copies of itself. On first starting ARVs for your antiretroviral treatment, your HIV viral load should drop significantly. During the first two months of therapy, an HIV-positive person’s viral load should drop to a minimum of 90 percent.

Benefits of starting ARV treatment immediately

  • An extended life.
  • Reaching a higher CD4 count and keeping it high.
  • Blocking additional damage to the immune system. 
  • Lessening the risk for HIV-related and non-HIV-related health complications.
  • Reducing your risk of transmitting HIV to others. 

Risks of delayed ARV treatment

  • A shorter life.
  • An extremely weakened immune system. This can lead to it taking longer to repair your immune system later.
  • Your condition can potentially develop into AIDS and other serious illnesses.
  • An accelerated chance of your failing health advancing some infections when you begin taking HIV drugs later, and have limited CD4 cells.
  • Transmitting HIV to others, inclusive of sexual partners and babies, if you become pregnant.

Blood Tests for ARV treatment

You will have baseline blood tests done prior to starting ARV treatment. Your health care worker will take blood for various tests. These are your original, or baseline, tests and subsequent test results will be compared to these original test results to check how your treatment is working.

  • CD4 cell (T-cell) count: The CD4 count checks the strength of your immune system. After you start HIV treatment, if your CD4 count is low, you should see it go up. Initially, your CD4 count should be checked every three to four months. When this count becomes stable, it should be checked every six months to one year.
  • Viral load test: The viral load (VL) test measures the amount of HIV in your blood. After you start HIV treatment, you should see your viral load go down. Your viral load should be checked around a month after starting or changing HIV medication. Your VL should be tested every three to four months until it becomes undetectable in your bloodstream. Your VL should be checked every six months once stable.
  • Resistance test: The resistance test helps regulate which drugs are likely to work against the strain of HIV that you have. Experts recommend that everyone get a resistance test before starting or changing HIV treatment. (HIV-1 has nine named strains: A, B, C, D, F, G, H, J, and K. Some of these have sub-strains).
  • Other tests to check your overall health: These include complete blood count (CBC), chemistry screen, lipid profile (cholesterol and fat), liver tests, and glucose (blood sugar). Your health care provider should inform you how often you will require these tests.

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