Understanding Care

Living with HIV can be challenging at times. Partnering with your health care provider will help you manage your health and HIV care.

During your medical appointments, your health care provider may:

• Conduct medical exams to see how HIV is affecting your body.
• Ask you questions about your health history.
• Take a blood sample to check your CD4 count and viral load.
• Look for other kinds of infections or health problems that may weaken your body, make your HIV worse, or prevent your treatment from working as well as possible.
• Give you immunizations, if you need them.
• Discuss, prescribe, and monitor your HIV medicines, including when and how to take them, possible side effects, and continued effectiveness.
• Discuss strategies that will help you follow your HIV treatment plan and maintain your treatment.
• Help identify additional support you may need, such as finding a social worker, case manager or patient navigator; finding an HIV support group; finding support services for mental health or substance use issues; or finding support services for transportation or housing.
• Ask you about your sex partners and discuss ways to protect them from getting HIV.
• Ask you about your plans for getting pregnant or getting your partner pregnant.

Talk regularly with your health care provider about how you are feeling and communicate openly and honestly. Tell your health care provider about any health problems you are having so that you can get proper treatment. Discuss how often you should expect to attend medical visits. Staying informed about HIV care and treatment advances and partnering with your health care provider are important steps in managing your health and HIV care.

Your health care provider will use blood tests to monitor your HIV infection. The results of these blood tests, which measure the amount of HIV virus and the number of CD4 cells in the blood, will help you and your health care provider understand how well your HIV treatment is working to control your HIV infection. These test results will also help your health care provider decide whether he or she should make changes to your treatment.

These blood tests include regular:

• CD4 counts, and
• Viral load tests.

CD4 Count

CD4 cells, also called T-cells, play an important role in your body’s ability to fight infections. Your CD4 count is the number of CD4 cells you have in your blood. When you are living with HIV, the virus attacks and lowers the number of CD4 cells in your blood. This makes it difficult for your body to fight infections.

Typically, your health care provider will check your CD4 count every 3 to 6 months. A normal range for a CD4 cell count is 500 cells to 1,600 cells per cubic millimeter of blood (you may see this written as “cells/mm3”). A low CD4 cell count means you are at higher risk of developing opportunistic infections. These infections take advantage of your body’s weakened immune system and can cause life-threatening illnesses. A higher CD4 cell count means that your HIV treatment is working and controlling the virus. As your CD4 count increases, your body is better able to fight infection. If you have a CD4 count of fewer than 200 cells per cubic millimeter of blood, you will be diagnosed as having AIDS.

Viral Load Test

Your viral load is the amount of HIV in your blood. When your viral load is high, you have more HIV in your body, and your immune system is not fighting HIV as well.

When you take a viral load test, your health care provider looks for the number of HIV virus particles in a milliliter of your blood. These particles are called “copies.”

The goal of HIV treatment is to help move your viral load down to undetectable levels. In general, your viral load will be declared “undetectable” if it is under 40 to 75 copies in a sample of your blood. The exact number depends on the lab that analyzes your test.

Your health care provider will use a viral load test to determine your viral load. A viral load test will:

• Show how well your HIV treatment is controlling the virus, and
• Provide information on your health status.

You should have a viral load test every 3 to 6 months, before you start taking a new HIV medicine, and 2 to 8 weeks after starting or changing medicines.

Antiretroviral therapy (ART) reduces viral load, ideally to an undetectable level. If your viral load goes down after starting ART, then the treatment is working. Having an undetectable viral load greatly lowers your chance of transmitting the virus to your sexual and drug-using partners who are HIV-negative. However, even when your viral load is undetectable, HIV can still exist in semen, vaginal and rectal fluids, breast milk, and other parts of your body, so you should continue to take steps to prevent HIV transmission. For example:

• HIV may still be found in genital fluids (semen, vaginal fluids). The viral load test only measures the amount of HIV in the blood. Although ART also lowers viral load in genital fluids, HIV can sometimes be present in genital fluids even when it is undetectable in the blood.
• Your viral load may go up between tests. When this happens, you may be more likely to transmit HIV to your partner(s). Your viral load may go up without you knowing it because you may not feel any different.
• Sexually transmitted diseases (STDs) increase viral load in genital fluids. This means that if you are living with HIV and also have an STD, you may be able to transmit HIV to your partner(s) even if the blood viral load is undetectable.

Researchers are studying how much you can lower your chances of transmitting HIV when your viral load is undetectable, and we should know more when these studies are complete.

If you are taking ART, follow your health care provider’s advice. Visit your health care provider regularly and always take your medicine as directed. This will give you the greatest chance of having an undetectable viral load. Taking other actions, like using a condom consistently and correctly, can lower your chances of transmitting HIV or contracting an STD even more.