Treatment Guidelines

The official Australian HIV treatment guidelines have changed a lot over the last few years. They now encourage people to consider taking treatments far earlier than they used to.

The current guidelines are based on an enormous amount of long-term scientific research. The most recent changes are the result of findings from the START study (May 2015) which showed the benefits of starting HIV antiretroviral treatment soon after diagnosis.

Treatment is now recommended for all people with HIV but is particularly important for people with a low or rapidly declining CD4 count, people with an associated medical condition, people aged over 45, and pregnant women.

Treatment should also be considered to prevent onward transmission of HIV, particularly for sero-discordant couples.

The Australian Treatment Guidelines state:

1. Antiretroviral therapy (ART) is recommended for all people with HIV, irrespective of CD4 count, to reduce the risk of disease progression.
2. Doctors should regularly discuss the current ‘state of knowledge’ about when to start ART with all people with HIV who aren’t on treatment.
3. All decisions to start ART should be made by the person with HIV, in consultation with their health care providers, so that they are fully informed and supported in their decision making.
4. The decision to start ART should take into account both personal health benefits and risks, and reduction in transmission risk.

There are six classes of HIV antiretroviral drugs which work in different ways to make it difficult for HIV to reproduce. They are commonly used in combination to maximise their effectiveness and prevent the development of drug resistance. This is known as ‘combination therapy’. Your doctor will help you work out the best combination for you by considering:

• an effective combination to suppress your viral load
• a dosing schedule that is a good fit with the demands of your daily life
• treatments that deliver manageable or no side-effects

If you start one treatment combination and it does not successfully lower your viral load or if it triggers difficult side-effects, you can usually try a different drug combination. It is very important you alert your doctor to difficulties as soon as possible so your doctor can help you manage a change of treatment. Do not stop taking the drugs without talking to your doctor.

Research on HIV treatments is ongoing and knowledge about HIV treatments continues to grow, so it is important to keep talking to your doctor to make sure you know about the most current evidence. Australian HIV treatment guidelines state all decisions about treatments remain with the person being treated, so you can make decisions that are right for you.

For more information on HIV treatments see AFAO’s HIV Tests & Treatment.

“I play a very active role in monitoring my health and also my treatment decision making. I have an excellent doctor who encourages me to be informed and participate in the process.”