Do You Need Antiretroviral Therapy for HIV with No Symptoms?

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Ask the experts

I am a 23 year old male and have been HIV+ for 2 years. I feel fine and still don't have any symptoms. Do I need to start antiretroviral therapy yet?

Doctor's response

Recommendations as to when antiretroviral therapy should be started are forever changing. Most recently, the guidelines have been modified to support delaying therapy in selected patients with high CD4 cell number and/or low viral loads. Details as to what the recommendations are and the rationale for the changes are outlined in my March 2001 Doctor's Column. In summary, the current guidelines from the US Department of Health and Human Services suggest therapy be considered for those individuals:

  • with symptoms of immunosuppression
  • without symptoms, if they have consistently less than 350 CD4 cells
  • without symptoms, if the CD4 cell count is greater than 350 with viral loads greater than 30,000 copies/ml using the bDNA method or 55,000 copies/ml using the PCR method

These are simply guidelines and must be individualized after detailed discussion with an experienced HIV-treating clinician. More important than any set of guidelines is the requirement that patients be fully committed to taking the treatment. Furthermore, patients need to work closely with their healthcare providers to minimize side-effects and optimize the consistent taking of the medications.

Thank you for your question.

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Reviewed on 1/11/2018