If your HIV test is positive, we will refer you to an NHS HIV Clinic to receive treatment and for ongoing support.
We will try to make this process as easy and supported as we can.
If you have any questions, please do get in touch.
If you have been exposed to HIV in the last 72 hours, please contact your sexual health clinic for PEP ASAP (learn more).
2. Discuss what this means
FAQs – HIV Treatment
Is there a cure for HIV?
For all practical purposes, there is presently no cure for HIV. However, HIV can be managed and those on effective treatment can live a full and flourishing life.
— A note on the two HIV ‘cures’ in the media —
Timothy Brown in 2007 (the ‘Berlin Patient’) and Adam Castillejo in 2019 ( “London Patient”) received a specialised bone marrow transplant for treatment of their cancers, not for HIV.
This treatment involved replacing their immune system with stem cells from donors who had a relatively rare genetic mutation that impedes the ability of HIV to enter the cells. This mutation is called the ‘Delta 32 mutation’ (CCR5-Δ32/Δ32 genotype). In effect, the stem cell transplant replaced Timothy and Adam’s immune system with one that was resistant to the HIV and thus ‘curing them of HIV’.
This approach is not a standard therapy for HIV due to the risk of this treatment and the relative rarity in finding suitable donors with a Delta 32 mutation. Furthermore, this treatment has failed to cure HIV in other patients treated for their cancers.
Certainly these case reports have managed to raise hope of finding a cure one day.
What is the treatment for HIV?
A combination of drugs are used to completely suppress the virus and are called HAART (Highly Active Anti-retroviral Therapy) or cART (Combination Anti-Retroviral Therapy). They first got introduced in 1996, and was a turning point in the history of HIV.
The way HAART works is by taking two drugs from one class to form the ‘backbone’ which in turn is reinforced with the addition of another drug called the ‘third agent’.
Traditionally 3 different drugs combinations have proved most effective and popular. Few patients are on single drug therapy, and a combination of 2 drugs has become available recently. A combination of 4 drugs have been tried in the past, without any additional benefits, and are not commonly used.
You may visit www.aidsmap.com for more information.
How successful is HIV treatment?
A wide range of treatment options are now available to suit the needs of an individual patient.
The aim of successful treatment is to achieve complete suppression of the virus in the blood. This is confirmed by the ‘undetectability’ of the HIV virus on a special blood test called HIV Viral Load [learn more]. More than 90% of patients in the UK who are on HAART achieve this.
Achieving an ‘undetectable’ Viral Load has a 3-fold benefit:
- improvement in symptoms caused by the HIV virus
- improvement in the immune system
- reduction in onward transmission
What does undetectable viral load mean?
Viral load is a measurement of the amount of virus in the blood of the person infected with HIV. This amount can vary from 0 to millions of copies of virus in per ml of blood. The higher the viral load, the more infectious the patient is and greater the adverse effect of the virus on the immune system.
When a patient starts on the HAART therapy, the viral load drops rapidly from its baseline, and becomes undetectable within a few weeks. Tests commonly used in the UK to measure viral load have a lower limit of detection set at 20 copies/ml. When the test is not able to detect any viral load, the viral load is said to be undetectable.
How long does it take for HIV treatment to work?
This can depend on the combination of drugs used. Some of the currently used drugs can drop the HIV viral load rapidly and achieve undetectability as soon as 4 weeks after starting treatment. Other drugs can take between 3-4 months to reach an undetectable HIV viral load.
When should I start HIV medication?
HIV therapy is started as soon as possible after a HIV diagnosis, to achieve the best outcome.
In the past, HIV treatment used to be recommended after CD4 T cell count, a marker of the immune system, dropped below a certain level.
The only group where HIV therapy is not needed are Elite controllers (link to elsewhere for details).
Are there any side effects?
Earlier generations of HAART had lots of side effects, making it difficult to take these medications on a long term basis for many patients. However, currently used drugs to treat HIV are very well tolerated, and cause minimal or no side effects in most patients. If a patient experiences serious or intolerable side effects, other drug choices are available to try.
Can I become resistant to HIV medication?
Resistance to HIV drugs can occasionally develop in patients who do not take their medications regularly. Development of resistance to one or more HIV drugs results in virus becoming detectable in blood and the weakening of the immune system.
To prevent drug resistance from developing:
- Emphasis is given on adherence to these medications by HIV doctors.
- A HIV Genotype Resistance test is done to select correct medications before starting therapy.
- Combining 3 different HIV drugs together also prevents the development of drug resistance.
- Patients on HIV therapy get their HIV viral load test done every 3-6 months. Regular tests allow failing drug therapy to be identified on time, and for preventive action to be taken.
What happens if I develop a resistance to HIV medication?
If you develop resistance to a HIV drug, you will be switched to a new set of medications without resistance.
As there are more than 20 drugs from 6 different classes currently in routine use to treat HIV, a HIV Genotype Resistance test will be carried out to guide the selection of the drugs that will work.
Can I take this with other medications?
Most medications for various medical conditions can be taken at the same time as HIV drugs.
However, some medications interact with certain HIV drugs, and this is taken into consideration while prescribing HIV drugs as well as other drugs. This will be discussed with your HIV doctor.
Where can I get treatment for HIV?
NHS provides treatment for HIV through Sexual Health Clinics. The service is confidential and free of charge.
Does my partner also need HIV treatment?
Your partner will only need HIV treatment if they also test positive for HIV.
It is important to note that not everyone who has sex with someone with HIV will get infected with the virus.
Can I have sex again?
We recommend having unprotected sex when your HIV treatment is working successfuly, as to eliminate the risk of passing the infection to a sexual partner. This will be when the level of the HIV virus is undetectable in your blood, as ascertained by a HIV Viral Load test.
In the meantime, you should use a condom.
Page reviewed by Dr. Manoj Malu (Clinical Director)
Last reviewed date: 21 April 2020
Next review due: 21 April 2023
Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.
Reference & Further Reading
- European AIDS Clinical Society: Guidelines Version 10.0 November 2019
- International AIDS Society: Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults2018 Recommendations of the International Antiviral
- New England Journal of Medicine: Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection | NEJM
- The Lancet: Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies
If you are experiencing symptoms
It is important to refer to a healthcare provider as soon as possible. Our experience combined with timely detection can help avoid complications in the future.