When is the right time for one to start taking ARVs? My HIV-positive sister was advised by a counsellor to start taking ARVs because she had an oral thrush. The counsellor said this meant she was in stage three of HIV infection and should be put on ARVs. However, when a doctor tested her CD4 count and viral load, he advised us to start her on Septrin only and not ARVs because her CD4 count was still high and the viral load low. After she was put on Fluconazole, the oral thrush went away. Whose word should we go with?
THE time to start antiretroviral therapy (ART) is indeed very important because many of the people who die soon after starting these drugs do so because they started too late, when the immune system had been irreversibly damaged.
The World Health Organistion (WHO) advises that all patients who are in stage three and four of the infection with serious opportunistic infections such as your sister should be started on ARVs.
These are guidelines to the clinicians who assess patients to determine eligibility for ART and not rules set in rock.
The advantage your doctor has is that in addition to clinical assessment on which the WHO staging is based, he has access to the patientâ€™s CD4 count and her viral load.
With these, he can comfortably decide whether your sisterâ€™s life is in serious danger in which case ART should be started immediately.
ART in this case can be differed and the laboratory tests repeated, say, in six monthsâ€™ time, while your sister undergoes comprehensive counselling to prepare her for ART and living with HIV.
When should one start treatment?