HIV Treatment – all you need to know


HIV Treatment

There’s no cure for HIV/AIDS, but many different drugs are available to control the virus.

Fast facts on HIV in South Africa in 2018 from UNAIDS:

  • 7 700 000 people were living with HIV.
  • 240 000 people were newly infected with HIV.
  • 90% of people living with HIV knew their status.
  • 62% of people living with HIV were on treatment.
  • 54% of people living with HIV were virally suppressed.
  • The number of young people in South Africa receiving treatment for HIV has increased 10-fold within a decade.

Anti-retro-viral treatment:

ART involves taking a combination of HIV medicines every day. It prevents HIV from multiplying and destroying your infection-fighting CD 4 cells. ART can’t cure HIV, but it can help you live a longer, healthier life and reduce your risk of HIV transmission.

NEW: SA is introducing an affordable, cutting-edge drug to fight HIV on the 1 of December 2019.

The new three-in-one pill, developed with the financial backing of global health development organisation Unitaid, bands together with the drugs tenofovir disoproxil fumarate, lamivudine and dolutegravir. The advanced pill known as TLD promises to be “the fastest way to reduce HIV viral load”.

Why is medication (ARV drugs) to fight HIV so important?

A main goal of ART is to reduce a person’s viral load to an undetectable level. The lower your viral load, the better.

When people with HIV take effective treatment, the amount of HIV in their body fluids falls drastically, to the point where there is not enough HIV to pass on to someone else.

A person has an undetectable viral load when there are so few viral copies of HIV in their blood that a blood test cannot detect them. Viral load is measured in units called ‘copies’. The standard blood tests used in clinics can measure viral load down to 20 or 50 copies per millilitre of blood. Anything less than this is called ‘undetectable’.

If someone has an undetectable viral load, it does not mean they are cured of HIV. They are still HIV positive. If they stop taking HIV treatment, their viral load will increase again.

Please note: Not everyone taking HIV treatment has an undetectable viral load. After starting HIV treatment, it can take as long as six months for a person’s viral load to become undetectable. Until then, they may still be infectious.

Undetectable = untransmittable

HIV treatment is highly effective in reducing the transmission of HIV. Evidence from numerous studies showed that people living with HIV with an undetectable viral load could not transmit HIV sexually.

Please note: You and your partner should not make any decisions about stopping using condoms until their viral load has been undetectable for at least six months.

What is a normal CD, 4 Count? The CD4 count is a test that measures how many CD4 cells you have in your blood. A normal CD 4 count is from 500 to 1,500 cells per cubic millimetre of blood.

  • CD4 cells are white blood cells that fight infections.
  • These are a type of white blood cell, called T-cells, that move throughout your body to find and destroy bacteria, viruses, and other invading germs.
  • CD4 T-cells are considered “helper” cells because they do not neutralize infections but rather trigger the body’s response to infections.

CD4 Cells & HIV Infection

When you are HIV positive, the very cells meant to initiate an immune defence and protect the HIV targets you. HIV is a retrovirus – retroviruses cannot replicate on their own, meaning they have to invade a host cell to complete their life cycle. HIV needs to infect certain “host” cells to make copies of itself. CD4 cells are the prime targets for this in the course of an infection.


HIV attaches to these helper cells during infection, emptying its genetic material so that the host’s genetic coding can be altered to produce other HIV virions. In doing so, the host CD4 cell is killed. The infected person’s ability to trigger an immune defence is gradually depleted to such a point as to leave their body open to opportunistic infections.

When the viral load in your blood is lowered by ART, it allows the CD 4 cells to reproduce and increase in number. The higher your CD 4 count, the better able you are to fight HIV and other infections.


It is recommended to start on ARV’s as soon as possible after being diagnosed. The urgency to start ART is even greater in people with low or rapidly falling CD 4 counts. A falling CD 4 count indicates that HIV is advancing and damaging your immune system. HIV treatment is now recommended to commence immediately when a person tests positive for HIV, as stated by the World Health Organization (WHO) in the 2016 guidelines.

A CD 4 count of less than 200 usually indicates the onset of AIDS.

AIDS is the final, most severe stage of HIV infection.

Because HIV has severely damaged the immune system, the body can’t fight off opportunistic infections. (Opportunistic infections are infections and infection-related cancers that occur more frequently or are more severe in people with weakened immune systems than in people with healthy immune systems.)

People with HIV are diagnosed with AIDS if they have a CD4 count of fewer than 200 cells/mm3 or certain opportunistic infections. Once a person is diagnosed with AIDS, they can have a high viral load and transmit HIV to others very easily. Without treatment, people with AIDS typically survive about 3 years


After you start ART, your HIV care provider will use your CD 4 count as one way to check how well your medication is working to monitor the effectiveness of your HIV regimen. Your HIV care provider will also monitor your CD 4 count to determine whether it has fallen to a level at which you might be at risk for certain opportunistic infections. In that case, your HIV care provider may prescribe some additional medications to prevent other infections.

Your HIV care provider will order a CD 4 count at your first visit after being diagnosed to establish a baseline level.

After that, we recommend that your HIV care provider order a CD 4 test every 3 to 6 months when you start ART to see how well you respond to treatment. Your HIV care provider may switch to every 6 to 12 months depending on your health status once treatment has increased your CD 4 levels to higher levels and your viral load is suppressed. If your CD 4 count reaches normal levels and your viral load remains suppressed, your HIV care provider may not check your CD 4 count unless there is a change in your health or viral load.

Your CD 4 count can vary from day to today. It can also vary depending on the time of day your blood is drawn and on whether you have other infections or illnesses, like the flu or sexually transmitted infections (STI’s). The trend of your CD 4 count (whether it’s rising or falling) over time is what’s really important—not an individual test result.

Most people starting HIV treatment report one or more side effects.  Sometimes, when we start a treatment, we are more sensitive to anything that happens, even though it might not be a side effect. Some side effects, like headaches or occasional dizziness, may not be serious. Other side effects, such as swelling of the throat and tongue or liver damage, can be life-threatening.

Not everyone taking drugs will have the same effects. What is important is how they affect you and what you can do about them. Never stop your medication on your own. Talk to your health professional about the side-effects you experience to help you with coping solutions. In severe cases, it is possible to change the medication you are on.  Most HIV drugs have a low risk of serious side effects.

The word ”symptom” is usually used to change how you feel that you could report to your doctor. For example, feeling tired or having diarrhoea are both symptoms that could be side effects. The symptoms of many common side effects are similar to symptoms of illnesses. Your doctor needs to know about every symptom to decide whether it is caused by treatment (a side effect) or a different illness.

Please note: Taking HIV medicines every day and exactly as prescribed—reduces the risk of drug resistance.

If you stop and start, stop and start taking your mediation to cope with side-effects, it can cause the virus to become resistant to the medication you are taking. This is the number of reason people develop drug resistance. If you become drug-resistant, it means treatment failure and that you will develop the last stage of HIV infection, namely AIDS.

What to do if I was accidentally exposed to the virus?

Get help



You can do a self-test quiz – the STD Quiz, to learn more about your risk of contracting an STD.




For help, support, counselling or more information, you may also chat with a facilitator on LIVE CHAT. The service is text-based, and you may remain anonymous.




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