Treatment as prevention: What you need to know
By Tamara E. Holmes
Every month, HIV specialist Theresa Mack, M.D., M.P.H.—an associate medical director at St. Luke’s Medical Group in Harlem, N.Y.—will answer your most pressing HIV/AIDS questions.
For years we’ve known that with effective treatment, HIV becomes a chronic illness rather than a fatal one. How-ever, there have been different schools of thought about when a person living with HIV/AIDS should begin treatment.
In the past, many HIV/AIDS specialists recommended that people with HIV delay treatment if their immune systems were strong. However, new developments have caused the HIV/AIDS community to rethink that previous wisdom.
Understanding the Logic
The question about when to begin treatment has largely centered on the number of CD4 cells a person with HIV has in his or her body. CD4 cells, also known as T cells, are white blood cells that fight infections, such as HIV. The higher your CD4 count, the healthier you are.
In the past, many HIV/AIDS specialists believed that if a person had a CD4 count of 500 or higher, he or she was healthy enough to put off treatment. Some of the earlier medications prescribed during antiretroviral therapy produced serious adverse effects, such as liver damage, hyperglycemia and skin rashes. The school of thought was that someone with a CD4 count of 500 or higher could wait to begin treatment and delay or perhaps even avoid these possible effects. On the other hand, a person with a CD4 count of 200 or below needed to start treatment as soon as possible.
But times have changed for three major reasons:
Medications are much more effective, so those who are in treatment are taking fewer pills and suffering fewer side effects.
Some studies suggest that earlier treatment may lessen an HIV patient’s risk of later acquiring AIDS-defining ill-nesses, such as HIV-associated nephropathy, HIV dementia and peripheral neuropathy.
A clinical trial in 2011 found that people with HIV who started taking medications while they had a high CD4 count saw their risk of transmitting HIV to their HIV-negative sexual partners decrease by 96 percent.
A New School of Thought
The realization that treatment could also be prevention was a landmark scientific break-through, giving the HIV/AIDS community a reason to believe that the end to the epidemic was in reach. Not only does treatment help the person with HIV remain healthy, but it also provides another layer of protection to those in the community who are HIV negative.
The Department of Health and Human Services recommends treatment for all PLWHA, and it has identified dual goals for treating the disease:
Destroy the virus and reduce the risk of disease progression;
Decrease the person’s risk of transmitting HIV—in effect, preventing new infections.
While it’s now recommended that all people with HIV begin ARV treatment even if they have a high CD4 count, it’s ultimately the decision of the patient. If you do have a high CD4 count and decide you’d rather not go on ARV drugs, make sure you stay in care so that your CD4 count can be monitored and you can begin treatment if it begins to decline.
Other Precautions Still Necessary
If you decide to begin ARV treatment, you must still take precautions. Treatment with ARVs is one form of prevention, but it’s not a foolproof method for preventing the spread of HIV. Antiretroviral treatment lowers your risk of transmitting HIV to others, but it doesn’t eliminate the risk entirely.
A person who is on ARVs should continue to use condoms whenever he or she has sex.
If an HIV-negative male or female has sexual intercourse without a condom or the condom breaks, he or she should go to a doctor or an emergency room to begin a PEP (postexposure prophylaxis) protocol, which may prevent HIV infection.
Treatment goes a long way toward keeping you and your sexual partners healthy, but having unprotected sex increases your risk of HIV infection every time.
Tamara E. Holmes is a Washington, D.C.-based journalist who writes about health, wealth and personal growth.