It’s not known for certain what is the best time to start treatment with anti-HIV drugs. This means you need to weigh up with your doctor, on an individual basis, the likely benefits and risks of starting treatment now as opposed to waiting until later.

However, it’s currently recommended in UK HIV treatment guidelines that you start anti-HIV treatments immediately if you are ill because of HIV, or have an AIDS-defining illness. It’s also recommended that you start treatment if your CD4 cell count is near or below 200, the level at which you become vulnerable to serious AIDS-defining illnesses, or is falling very rapidly. But UK treatment guidelines are likely to change very soon and recommend starting anti-HIV treatmet at higher CD4 cell counts - around 350. New European guidelines recommending this were issued in October 2007.

UK treatment guidelines also make other recommendations about whether you should take HIV treatments, depending on the length of time you have been infected with HIV, the level of your CD4 cell count and the amount of HIV in your blood – your viral load.

Recently infected with HIV?

The six months after you are infected by HIV is called primary HIV infection. There is no proof that taking treatment at this time will mean that you live a longer, healthier life. Some doctors believe, however, that treatment at this time may offer a unique chance to control HIV which may be lost later, as your immune system sustains ongoing damage due to HIV, and becomes less able to attack HIV. Whatever your CD4 cell count, if you are considering treatment soon after infection, you should start as soon as possible, and certainly within six months of infection with HIV. Clinical trials have looked at the risks and benefits of treatment at this time and their results are expected within the next few years.

Until the results of these trials are are available, treatment at this stage is only recommended for people who have developed an AIDS defining illness; people who have neurological (brain) symptoms of HIV; and people who have had a CD4 cell count below 200 for three months or so.

Infected with HIV for over six months, but without symptoms?

Your doctor should discuss starting anti-HIV treatment when your CD4 cell count is around 350. You are recommended to start treatment as soon as you are ready after your CD4 cell count has fallen to 350. It's particularly important that you start treatment around this time is you have any of these characteristics:

**Symptoms of HIV.

**A high viral load.

**A rapidly falling CD4 cell count.

** Aged over 50.

**Infected with hepatitis B or hepatitis C.

** Have a risk of heart disease.

Some doctors also think that earlier treatment should be a priority if you are of African racial origin and have kidney disease.

If you are advised to start treatment but choose not to, then you should review your decision regularly and have your CD4 count and viral load monitored more frequently than usually recommended, for example every two months.

Infected with HIV for over six months, and ill because of HIV?

Regardless of your CD4 cell count, doctors recommend that you should take anti-HIV treatments if you are becoming ill because of HIV.

A possible exception, however, would be if you have tuberculosis. There are potential interactions between anti-HIV drugs and a key medicine used to treat tuberculosis. Because of this, many doctors recommend delaying treatment with anti-HIV drugs until a person has taken at least two months of tuberculosis treatment. Similarly, if you become ill with tuberculosis whilst taking HIV treatment, you may be recommended to stop taking anti-HIV drugs for the first two months of tuberculosis treatment.

If your CD4 cell count is below 200 you should start anti-HIV treatment immediately. This is because you have a risk of developing potentially life-threatening illnesses when your CD4 cell count is this low. You may also need to take small doses of some antibiotics to prevent you developing some infections until your CD4 cell count increases to over 200 - 250.