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Most of us wait until a disease shows up before doing anything about it—"if it ain't broke, don't fix it." In HIV disease, the immune system starts to "break" immediately, not just when opportunistic infections show up. Thus, monitoring the health of the immune system is critically important. There are two common approaches for doing this: (1) Symptom Observation and (2) Lab Tests. Each has advantages and disadvantages.

This approach waits for active infections and disease to occur. In HIV, this means watching out for such things as thrush, pneumocystis, KS lesions and so on.

• Advantages
  It is easier to believe and take action when we are faced with an obvious illness. People who feel sick usually want to treat the illness as soon as possible.
• Disadvantages
  HIV may progress before symptoms appear. By the time symptoms appear, options for treating the problem may be less effective because the body is left with only limited defenses.

• HIV-antibody testing
• CD4+ cell testing
• Viral load testing
• Basic blood tests

• Advantages
  Indications of illness show up before illness becomes apparent. The tests enable patient and doctor to act to prevent serious infections before they occur and to act on the basis of hard numbers, not just guesses.
• Disadvantages
  It is difficult to act on test results, since you often feel fine no matter what the lab numbers say. People who feel healthy may be less motivated to begin treatment. Test results are variable, changing for many reasons.

Because HIV infection can be a life-or-death matter, it is critical to choose the second approach. Taking a preventive approach makes it possible to:

• use treatments when they are most effective
• prevent the most serious infections
• slow the rate of disease progression and permanent damage to the immune system.

Some people say they hesitate to act before they are sick because today's treatments are not perfect, hoping to wait for something better to come along. However, no one knows when perfect treatments will become available. It is now well proven that today's treatments can extend survival time. Although we can't predict the results in every case, we do know what generally happens without treatment.

The purpose of preventive action is to slow the progress of HIV. Once infected, you have one chance to manage HIV disease correctly, so consider your options carefully and learn how to tell if a therapy is working for you. A preventive approach is the one which seems to offer the clearest hope.