勞拉‧奧爾邁爾 / 2024 年 3 月 / aidsmap

關鍵點

• 儘早開始愛滋病治療比晚開始更好。

• 治療將降低愛滋病毒傳播的風險、預防疾病並延長生命。

• 有多種不同的愛滋病毒藥物可供選擇。

建議所有診斷出愛滋病毒的人接受愛滋病毒治療。 儘早開始愛滋病毒治療比延遲更有益於您的健康。

抗愛滋病毒藥物透過降低血液中的愛滋病毒含量（病毒量）發揮作用。 HIV治療的目的是使病毒量達到不可檢測的水平。 這意味著血液樣本中的愛滋病毒含量非常低，以至於無法使用標準測試檢測出來。 減少血液中的 HIV 含量可以增強您的免疫系統（透過 CD4 細胞數來衡量）。 CD4 細胞數量越高，因 HIV（也可能還有其他一些嚴重疾病）而生病的風險就越低。

您應該與您的醫生討論開始愛滋病毒治療的最佳時間。 您可能需要考慮許多因素，包括：

• 現在開始治療的好處。

• 延遲開始治療的潛在風險。

• 您現在準備好開始治療了嗎？

• 您的生活中是否還有其他因素影響您開始接受愛滋病毒治療的能力？

可能還有其他與您的治療和照護相關的事情，您可能還有其他問題。 在前往診所預約之前，最好花一些時間考慮這些問題。

何時開始治療

您越早開始接受愛滋病毒治療，您就能越早受益。 英國和世界其他地方的愛滋病毒治療指南均建議所有愛滋病毒感染者都應接受愛滋病毒治療，無論其 CD4 數量如何。

一旦您準備好，就可以開始接受愛滋病毒治療。

2015 年，一項進行良好的大型研究顯示，即使 CD4 細胞數量較高，盡快開始治療也有好處。 研究清楚地顯示，儘早開始愛滋病毒治療對健康結果有正面影響，並降低愛滋病和其他嚴重疾病的風險。 這項研究的長期追蹤顯示，這些益處在加入研究約 10 年後仍然存在。 雖然人們有時會擔心抗愛滋病藥物的副作用，但研究也顯示，較早開始愛滋病治療的人比等待治療的人有更好的生活品質。

開始治療的另一個重要好處是，它通常會將體液中的愛滋病毒含量抑製到「不可檢測」的水平。 病毒量無法檢測意味著您的體液中沒有足夠的愛滋病毒，無法在性行為中傳播愛滋病毒。 換句話說，你沒有傳染性。 這也稱為「無法檢測到等於不會造成傳播」(U=U)。

其他研究顯示，透過愛滋病毒治療，許多愛滋病毒感染者可以擁有相對正常的壽命。

如果您的 CD4 細胞數低於 200，則盡快開始 HIV 治療尤為重要。 CD4 細胞數量越低，感染和 HIV 使您生病的風險就越大。

同樣，如果您最近（在過去三個月內）感染了愛滋病毒，您的醫生可能會鼓勵您立即開始治療。 這是因為有些人在感染後很快就會病情嚴重。 感染後立即開始治療可以減少生病的機會。 它還為您在感染愛滋病毒時提供保持正常免疫系統的最佳機會。

雖然對大多數人來說，盡快開始治療的醫療理由是明確的，但開始治療的決定取決於愛滋病毒感染者。 在開始治療之前，了解其工作原理及其涉及的內容非常重要。 您可能需要一些時間才能準備好開始。

從哪些抗愛滋病藥物開始治療

首次開始愛滋病毒治療的人的標準治療是三種不同藥物的組合。 抗愛滋病毒藥物根據其對抗愛滋病毒的作用方式分為不同的類別。 抗HIV藥物的主要類別是核苷​​反轉錄酶抑制劑（NRTI）、非核苷反轉錄酶抑制劑（NNRTI）、增強蛋白酶抑制劑和整合酶抑制劑。 在英國，愛滋病毒治療和照護標準由英國愛滋病毒協會 (BHIVA) 制定，該協會是愛滋病毒醫生和其他醫療保健專業人員的專業協會。 他們的愛滋病毒治療指南會定期審查，此頁面上次審核時間為 2024 年 3 月。

Starting HIV treatment

Laura Ohlmeier / March 2024 / aidsmap

Key points

• It’s better to start HIV treatment sooner, rather than later.
• Treatment will reduce the risk of HIV transmission, prevent illnesses and extend your life.
• A range of different HIV medications are available.

Everyone who has diagnosed HIV is recommended to take HIV treatment. It’s better for your health to begin HIV treatment sooner, rather than later.

Anti-HIV medications work by lowering the amount of HIV in the blood (viral load). The aim of HIV treatment is an undetectable viral load. This means that the amount of HIV in a blood sample is so low that it cannot be detected using a standard test. Reducing the amount of HIV in your blood allows your immune system (measured by your CD4 cell count) to strengthen. The higher your CD4 cell count, the lower your risk of becoming ill because of HIV (and possibly some other serious illnesses as well).

You should discuss with your doctor the best time for you to start HIV treatment. There are a number of factors you might want to consider, including:

• The benefits of starting treatment now.
• The potential risks if you delay starting treatment.
• Are you ready to start treatment now?
• Are there other factors in your life that affect your ability to start taking HIV treatment?

There may be other things which are relevant to your treatment and care and you may have other questions. It’s a good idea to take some time to think about these before you go to an appointment at your clinic.

When to start treatment

The sooner you start to take HIV treatment, the sooner you can benefit from it. HIV treatment guidelines, both in the UK and elsewhere in the world, recommend that all people with HIV should take HIV treatment, regardless of their CD4 count.

You can start taking HIV treatment as soon as you feel ready.

In 2015 a large, well-conducted study demonstrated that there are advantages to starting treatment as soon as possible, even with high CD4 cell counts. The study clearly demonstrated that starting HIV treatment earlier has positive effects on health outcomes and reduces the risk of developing AIDS and other serious illnesses. A long-term follow-up of this study showed these benefits were still present around 10 years after joining the study. While people sometimes worry about the side effects of anti-HIV medications, the study also showed that people who began HIV treatment earlier had a better quality of life than people who waited.

Another important benefit of starting treatment is that it usually suppresses the amount of HIV in your body fluids to an ‘undetectable’ level. Having an undetectable viral load means that there’s not enough HIV in your body fluids to pass HIV on during sex. In other words, you are not infectious. This is also called ‘undetectable equals untransmittable’ (U=U).

Other research has shown that with HIV treatment, many people living with HIV can have a relatively normal lifespan.

If your CD4 cell count is below 200, it’s especially important that you begin HIV treatment as soon as possible. The lower your CD4 cell count, the greater the risk of infections and HIV making you ill. Similarly, if you have caught HIV very recently – within the past three months – your doctor is likely to encourage you to start treatment without delay. This is because some people can become seriously ill soon after infection. Starting treatment very soon after infection reduces the chances of illness. It also gives you the best chance of having a normal immune system while living with HIV.

While the medical case for starting treatment as soon as possible is clear cut for most people, the decision to start treatment rests with the person living with HIV. Before starting treatment, it’s important that you understand how it works and what it involves. You may need a little time before you feel ready to start.

Which anti-HIV medications to start with

Standard treatment for people starting HIV treatment for the first time is a combination of three different medications. Anti-HIV medications belong to different classes depending on the way they work against HIV. The main classes of anti-HIV medications are nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), boosted protease inhibitors and integrase inhibitors. 

In the UK, standards for HIV treatment and care are set by the British HIV Association (BHIVA), the professional association for HIV doctors and other healthcare professionals. Their guidelines for HIV treatment are reviewed regularly.

This page was last reviewed in March 2024. It is due for review in March 2024.