HIV is a virus which attacks the immune system – the body’s defence system against infection and illness. If you have HIV, you can take drugs to reduce the level of HIV in your body. By taking these drugs, you can slow down or prevent damage to your immune system. These drugs are not a cure, but they can help you stay well and lead a long and healthy life. Nowadays, many people with HIV can expect to live a normal lifespan.

HIV belongs to a family of viruses called retroviruses, so treatment for HIV is known as antiretroviral therapy, sometimes referred to as ART.

HIV mainly infects cells in the immune system called CD4 cells. These are just one of many types of cells in the body’s immune system, but they play an essential role in how the body responds to infections and other illnesses. With HIV infection, over time the number of CD4 cells drops gradually but continually and the immune system is weakened. It becomes unable to fight infections and a condition called AIDS (acquired immune deficiency syndrome) follows. Antiretroviral drugs work by interrupting this process. 

A person with untreated HIV may have thousands or even millions of HIV particles (‘copies’) in every millilitre of blood.

The aim of treatment is to reduce the amount of HIV (known as viral load) to very low levels; this is called an ‘undetectable’ viral load.

All viral load tests have a cut-off point below which they cannot reliably detect HIV. This is called the limit of detection. Tests used most commonly in the UK have a lower limit of detection of either 40 or 50 copies/ml, but there are some very sensitive tests that can measure below 20 copies/ml. If your viral load is below 50 copies/ml, it is usually said to be undetectable.

You can find out more about viral load testing in NAM’s booklet CD4, viral load & other tests.

To give you the best chance of reducing the amount of HIV in your blood to an undetectable level, your doctor will usually recommend that you take a combination of three antiretroviral drugs (sometimes known as highly active antiretroviral therapy, or HAART).  In some combinations, three drugs are available already combined in a single tablet.

Once your viral load has become undetectable, your immune system should begin to recover. If you have been ill because of HIV, your ability to fight infections and your general health are likely to improve. 

In the UK, standards for HIV treatment and care are set and monitored by the British HIV Association (BHIVA), the professional association for HIV doctors and other healthcare professionals. These standards are reviewed regularly. The most recent guidelines on HIV treatment for adults were produced in 2015.

There have been huge improvements in HIV treatment over the last ten years or so. Compared to many older anti-HIV drugs, the ones used most widely today are more powerful, cause fewer side-effects, are easier to take and less likely to cause resistance. Currently available HIV treatment is highly effective for most people.

You can keep up with the latest developments in HIV treatment by regularly visiting NAM’s website, www.aidsmap.com or by signing up to one of our email bulletins: www.aidsmap.com/bulletins.