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HIV Treatment

Just Diagnosed: Next Steps After Testing Positive for HIV

(Last updated 5/7/2014; last reviewed 5/7/2014)

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Key Points

  • For people with HIV, the first step after testing HIV positive is to see a health care provider.
  • People with HIV work closely with their health care providers to make important decisions, such as when to start treatment and what HIV medicines to take. Making these decisions begins with a baseline evaluation.
  • A baseline evaluation includes a review of the person’s health and medical history, a physical exam, and lab tests. 
  • Results from a baseline evaluation are used to determine the stage of the person’s HIV infection, assess the person’s readiness to start HIV medicines, and guide selection of the person’s first HIV regimen

What is the next step after testing positive for HIV?

Testing positive for HIV often leaves a person overwhelmed with questions and concerns. So the first step after testing positive is to see a health care provider.

People with HIV work closely with their health care providers to make important decisions, such as when to start treatment and what HIV medicines to take. Making these decisions begins with a baseline evaluation.

What is an HIV baseline evaluation?

A baseline evaluation includes all the information collected during a person’s initial visits with a health care provider. An HIV baseline evaluation involves a review of the person’s health and medical history, a physical exam, and lab tests.

The purpose of a baseline evaluation is to:

  • Determine the stage of the person’s HIV infection
  • Evaluate the person’s readiness to start treatment
  • Collect information to guide selection of the person’s first HIV regimen

As part of the baseline evaluation process, the health care provider also explains the benefits and risks of HIV treatment and discusses ways to reduce the risk of passing HIV to others. The health care provider also takes time to answer any questions.

What are some questions people with HIV typically ask during their first visits with an HIV health care provider?

People often ask their health care providers the following questions:

  • Because I have HIV, will I eventually get AIDS?
  • What can I do to stay healthy and avoid getting other infections?
  • How will HIV treatment affect my lifestyle?
  • How should I tell my partner that I have HIV?
  • Is there any reason to tell my employer and those I work with that I have HIV?
  • Are there support groups for people with HIV?
Many people find it helpful to write down questions before a medical appointment. Some people bring a family member or friend to their HIV appointments to remind them of questions to ask and to jot down the answers.

What lab tests are included in a baseline evaluation?

The following tests are conducted as part of a baseline evaluation.

CD4 count
A CD4 count measures the number of CD4 cells in a sample of blood. CD4 cells are infection-fighting cells of the immune system. HIV destroys CD4 cells, which damages the immune system. A damaged immune system makes it hard for the body to fight off infections. Treatment with HIV medicines (antiretroviral therapy [ART]) prevents HIV from destroying CD4 cells.

ART is recommended for everyone with HIV, but the urgency to start ART is greater in people with low or rapidly falling CD4 counts. A falling CD4 count indicates that HIV is advancing and damaging the immune system.

The CD4 count is also used to monitor the effectiveness of HIV medicines once ART is started.

Viral load
A viral load test measures how much virus is in the blood (viral load). A goal of HIV treatment is to keep a person’s viral load so low that the virus can’t be detected by a viral load test. A high viral load increases the urgency to start ART.

Drug-resistance testing
Drug-resistance testing identifies which, if any, HIV medicines will not be effective against a person’s strain of HIV. Drug resistance test results are used to guide selection of an HIV regimen.

Testing for sexually transmitted infections (STIs)
Coinfection with another STI can cause HIV infection to advance faster and increase the risk of HIV transmission to a sexual partner. STI testing makes it possible to detect and treat any STIs promptly.

A baseline evaluation also includes other tests, such as a blood cell count, kidney and liver function tests, and tests for hepatitis.

How does a baseline evaluation help determine if a person is ready to start HIV treatment?

Before starting treatment, people with HIV must be prepared to take HIV medicines every day for the rest of their lives. A baseline evaluation can help to identify any issues that can make medication adherence difficult, such as lack of health insurance or alcohol or drug abuse. (Medication adherence means taking HIV medicines every day and exactly as prescribed.) Health care providers can recommend additional support to help people deal with these issues before treatment starts.

This fact sheet is based on information from these sources:

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