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Sexual health and LGBT population
Living with HIV
Post-exposure prophylaxis (PEP)
The ideal moment to begin medications intended to suppress and control HIV may vary from one person the next. When evaluating your need for therapy, your physician will look at a combination of factors:
If your infection is quite advanced (stage 3 or 4) and you are suffering from symptoms/complications secondary to HIV, your physician will recommend that you start antiretrovirals (anti-HIV medications).
When your CD4 cell counts fall below 200, you are at risk of developing an opportunistic infection (an infection that takes advantage of your weakened immune state). Opportunistic infections can lead to serious complications, and at times be fatal. If you have less than 200 CD4 cells your physician will recommend that you begin antiretrovirals.
On the other hand, if your CD4 cell counts are greater than 500, your immune system is considered to be strong enough to protect you from your environment – opportunistic infections would be rare. This is good news! Your physician will recommend that you wait…antiretrovirals are not indicated at this level of immune function (UNLESS! You have symptoms caused by HIV – discuss this exception with your doctor).
The grey zone is when the CD4 cell counts fall somewhere between 350 and 500, that regular follow-up is extremely important. Routine testing will enable you and your physician to select the appropriate moment to commence antiretrovirals – This level of CD4 counts is relatively strong and able to protect against most infections. Your physician may or may not recommend treatment for HIV – At these levels of CD4 cell counts the decision to initiate therapy is individualized – case by case. Speak with your doctor. Current research is tending towards treatment initiation for CD4 levels that are declining towards and below 350.
Starting medications is an extremely important step – one that requires an adapation period. Psychologically you must be ready to accept and start therapy. Perceptions, misperceptions and feelings you may have pertaining to medications or pills in general are important to recognize and address…they may influence your treatment success.
Given the important role you have as the manager of your medication taking, your physician will evaluate your readiness and capacity to initiate antiretrovirals. Please ensure that you are at ease in discussing your concerns regarding treatment initiation with your doctor. If therapy is indicated, and you are not “ready” – speak with your physician or related health-care expert on avenues designed to assist you in getting ready to “get started”.
In addition, there are several other factors that may influence the moment that you begin treatment. Concomitant infections may need to be treated prior to starting medications against HIV. Existing health problems may need to be stabilized prior to commencing medications. Pregnancy will have a significant impact on the timing of antiretroviral initiation etc. Feel free to discuss the impact co-existing health conditions may have on starting antiretrovirals.
Of note: from time to time individuals express their desire to defer treatment until they are ill. This approach is not free of risk. It is important to remember that when an individual with HIV progresses to the point of AIDS (symptoms relating to immune dysfunction) their weakened immune status places them at risk for opportunistic infections. These infections, poorly controlled by a compromised immune system may be difficult to treat, may require hospitalization, may result in long-term side-effects or complications and may at times be fatal. Ideally, the purpose of intervention with combination medications against HIV is to PREVENT the ultimate progression to AIDS and thus avoid the potential health problems inherent to this advanced stage of infection.