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Adherence and dealing with side-effects of antiretroviral treatment for HIV

Monitoring and switching treatment


  • Antiretroviral treatment (ART) reduces the level of HIV in your blood so that it cannot damage your immune system. 
  • If you do not take your medication correctly (at the right time every day), the level of HIV in your blood may increase and the treatment may stop working. This is known as developing drug resistance. 
  • Regular blood tests will show if your treatment is working by measuring  the level of HIV in your blood (viral load) and the strength of your immune system (CD4 count). 
  • If you have side effects that do not go away or your treatment stops working, your healthcare professional can advise you to change to a different combination of antiretroviral (ARV) drugs.

Once you start taking HIV treatment, it’s important that you take it every day. Your healthcare professional will explain how many pills to take, how often to take them, and whether you should take them with food.

It is your right to choose whether to take HIV treatment, when to start and whether to stop, but you should never simply stop taking your treatment. If you have any problems, questions or concerns about your treatment or health, talk to your healthcare professional and they will be able to help you make an informed decision. 

Why is it so important to take my medication every day?

ARV drugs keep HIV under control, but they don’t stay in your body for a long time, so you have to keep topping them up. 

If you stop taking your HIV drugs, then your viral load will go up. This means HIV can damage your immune system, and that you are more likely to pass HIV on. 

If you regularly miss doses of your HIV treatment, there is a risk that the HIV in your body will become resistant to the medication and the drugs will no longer work even when you do take them. 

So, it is important to take your treatment correctly – the right dose, at the right time, with or without food. There are many ways you can get help to remember to take your treatment every day (this is known as adherence). 

If you know there will be a change to your normal routine – for example if you are going to be staying away from home – then plan what you can do to keep taking your treatment on time. For example, you may find it helpful to set an alarm on your phone and carry extra ARVs in case you are delayed. 

Most people forget to take their treatment once in a while. However, if you find you often forget, then talk to your healthcare professional honestly about it. If they know you are having problems, they can offer support and advice before your treatment stops working.

How can I tell if my treatment is working?

Regular blood tests will show how well your treatment is working. The main blood test used to monitor how your body is responding to treatment measures the viral load (how much of the HIV virus is in your blood). 

The aim of HIV treatment is to lower your viral load and then to keep it as low as possible. When your viral load is very low, it is not possible for tests to measure it. This is a really good result, your viral load is called undetectable. You still have HIV, but it is being kept under control by the HIV treatment. Not only should you feel healthy, but if your viral load is undetectable, you cannot transmit HIV.

WHO recommends that you have a viral load test at 6 and 12 months after you start taking treatment, and then once every year. If treatment is begun early enough and followed correctly, your viral load can become undetectable within 6 months. 

The other main blood test is a CD4 count, which shows the strength of your immune system. CD4 cells, an important part of your immune system, are attacked by the HIV virus. When you start taking treatment the numbers of CD4 cells you have (your CD4 count) will go up and if you were feeling ill because of HIV, you should start to feel better. 

In some countries, viral load testing is not available. If this is the case where you are, your healthcare professional will monitor your health and your CD4 count in other ways.

My HIV treatment has side-effects. What can I do?

Many people experience some mild side-effects, particularly in the first few days and weeks of starting treatment. For example, you might feel sick or have a headache. Although unpleasant, most side-effects should improve and go away altogether as your body gets used to taking the drug. 

Some side-effects may be less obvious to you. For example, the commonly used drug TDF (tenofovir) can cause problems with the kidneys. Your healthcare professional will check a sample of your urine to look out for early signs of kidney problems.

If you think you are experiencing a side-effect, the best thing you can do is talk to a healthcare professional about it. They can advise you what to do and may prescribe something for you to take for a short period, such as an anti-nausea drug. If a side-effect doesn’t go away and is affecting your quality of life, you should be able to change to a different drug.

Could my treatment stop working?

For many people, the treatment they start taking will continue to work for as long as they take it. 

If your viral load is not being kept under control by the treatment you are taking, your healthcare professional will want to find out why. It may be that you are having problems taking the drugs correctly, that they do not interact well with other drugs that you are taking or that your virus has become resistant to them. 

Your healthcare professional may be able to help you resolve the problem and stay on the same treatment. However, if your treatment has stopped working, perhaps because of drug resistance, then you will be advised to change treatment. There are a number of HIV drugs, so your healthcare provider should be able to find a combination of drugs that is effective for you.

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Photo credit: © Photos are used for illustrative purposes. They do not imply any health status or behaviour on the part of the people in the photo.

Last full review: 
15 October 2019
Next full review: 
15 October 2021
Last updated:
15 April 2020
Last full review:
15 October 2019
Next full review:
15 October 2021