So which is it? Is it better to start therapy early or wait until my CD4 cell count drops?

We now know that HIV cannot be cured, or "eradicated," using the anti-HIV drugs that are currently available. However, we do know that therapy should be started—and continued—before HIV has had a chance to cause serious damage to the immune system. In this sense, it is always best to start therapy before symptoms of AIDS occur.

There is still some debate though on just how early treatment should start. More specifically, it is not clear if antiretroviral therapy should be started before the CD4 count falls below 350. While there are some potential benefits of early treatment, there are also possible risks. Here is a list of both, to help you and your healthcare provider determine if early treatment may be right for you:

Potential Benefits

• Keep your CD4 count high and possibly prevent irreversible damage to the immune system.
• Decrease your risk of certain HIV-related health problems that can sometimes occur in people with CD4 counts above 350, including tuberculosis, non-Hodgkin's lymphoma, Kaposi's sarcoma, peripheral neuropathy, cancers and pre-cancers caused by human papillomavirus (HPV), and mental deficits seen in some people with HIV such as difficulty thinking and reasoning (neurocognitive problems).
• Decrease your risk of serious health problems that occur more frequently in HIV-positive people, such as cardiovascular disease, kidney disease, liver disease, and various non-AIDS-related cancers and infections.
• Reduce your risk of transmitting HIV to others.

Potential Risks

• Risk developing treatment-related side effects.
• Risk developing HIV drug resistance, resulting in loss of future treatment options.
• Less time for you to learn about HIV and its treatment, and less time to prepare for adherence to therapy.
• Premature use of treatment before the development of more effective, less toxic, and/or better studied combinations of HIV drugs.
• Increased risk of transmitting drug-resistant HIV to others if you have a detectable viral load while on treatment.

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