Who Needs ART?

Not everyone who is living with HIV needs to start ART right away. Only the health care team, with the client, can make the decision when to start ART.

For adults to start ART, they must have an HIV-positive test result and meet clinical and social criteria. Check with your national guidelines. Note there are different criteria for children.

Clinical staging (a check-up by the doctor or nurse looking for specific symptoms and signs of HIV and AIDS):

  • If the person (including children) is very ill, losing weight very fast and has many opportunistic infections, such as bad diarrhea, fever or TB, she or he will usually need to begin ART immediately, no matter what the CD4 cell count.
  • Some illnesses get worse more quickly in a person living with HIV. In many of these illnesses, your doctor will recommend that you start HAART, even if you are usually well and have a normal CD4 count.

CD4 test (check your national ART guidelines):

  • CD4 cell count of 350 or less, even if the person does not show any symptoms
  •  For pregnant women, anyone who has a CD4 cell count below 350 should start HAART right away. If CD4 is above 350, HAART should be started at the beginning of the second trimester (second 3 months of pregnancy).
  • For children below age 5 years, HAART is started regardless of CD4 count. For children older than 5 years, HAART is started if CD4 count is less than 350.

If your doctor says you or your child needs ART:

  • Speak with your doctor or other members of your health care team to address any questions or concerns you have.
  • Know the names of the medications taken by you or your child
  • Know the possible side effects of the medications you are taking
  • Be committed to lifelong adherence
  • Try to find someone who will support you in adhering to treatment and care
  • Seek and be willing to accept advice and suggestions on ways to adhere to treatment and care


  1. The Comprehensive Peer Educator Training Curriculum: Trainer Manual International Center for AIDS Care and Treatment Programs, Columbia University