When should antiretroviral therapy for HIV be started?

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Thursday 11th January 2007

The point during the course of HIV infection at which antiretroviral therapy (ART) should be initiated remains uncertain. This is reflected in the extent of recent changes in recommendations for treatment guidelines. After a shift in the mid to late 1990s towards earlier initiation of ART - with the most aggressive guidelines suggesting initiation of ART in the overwhelming majority of people diagnosed with HIV - the more recent trend has been for later starting, with a delay in initiation until the CD4 cell count has fallen to 200 × 106 cells/l in the most conservative versions. The time difference between starting ART according to the most aggressive and the most conservative criteria is on average over 5 years, and for some people could mean a potential ART delay of over 10 years; consequently, this issue is of major relevance.

The point during the course of HIV infection at which antiretroviral therapy (ART) should be initiated remains uncertain. This is reflected in the extent of recent changes in recommendations for treatment guidelines. After a shift in the mid to late 1990s towards earlier initiation of ART - with the most aggressive guidelines suggesting initiation of ART in the overwhelming majority of people diagnosed with HIV - the more recent trend has been for later starting, with a delay in initiation until the CD4 cell count has fallen to 200 × 106 cells/l in the most conservative versions. The time difference between starting ART according to the most aggressive and the most conservative criteria is on average over 5 years, and for some people could mean a potential ART delay of over 10 years; consequently, this issue is of major relevance.

Full article available at:
Official Journal of the AIDS Society