HIV/AIDS: When to Start Antiretroviral Therapy?

Abstract

The optimal time to start antiretroviral therapy (ART) for human immunodeficiency virus (HIV)-infected individuals remains uncertain. Although current ART regimens are effective in suppressing viremia and enhancing immune function and are increasingly convenient and well tolerated, ongoing concerns remain about adherence, drug-related toxicities, drug resistance, and cost. Although few clinical trials results are currently available to inform the question of when to start ART, large clinical cohorts clearly have demonstrated the benefits of earlier initiation of ART for reducing both HIV-related and non-HIV-related clinical events. Additional data suggest that the strategy of earlier initiation of ART is cost-effective and efficient. Consequently, many antiretroviral guidelines from around the world now recommend routine initiation of ART when the CD4 cell count decreases to <350 cells/microL or at higher CD4 cell counts for certain subgroups of HIV-infected individuals, such as pregnant and/or breast-feeding women and persons with HIV-related nephropathy or hepatitis virus coinfection. Additional cohort and clinical trials data are needed.

The link between religion and HAART adherence in pediatric HIV patients

“…All 18 subjects were on HAART, defined as at least three different antiretroviral drugs including two nucleoside reverse transcriptase inhibitors combined with either a protease inhibitor or a non-nucleoside analog (Wilkin & Gulick, 2008). Combination pills were involved in the treatment regimen for 72% of the patients.…”

An Analysis of CLINICAL Signs and symptoms which best Predict the Need for Haart Initiation in HIV Infected South African Women.

“…The small numbers in this category could make some associations to be due to chance and lead to a lack of accuracy in sensitivity calculations. Initiation of HAART would have been deferred in these patients until they reached a more advanced HIV clinical stage when treatment outcomes are likely to be less successful (Wilkin, 2008). This study shows that certain signs are strongly associated with the need to initiate treatment.…”

A critical take on the World Health Organization’s new ‘test and treat’ strategy: making a case for resource-constrained countries

“…The precise time as to when to start the antiretroviral treatment was generally left to the discretion of the medical personnel in individual countries. As late as 2008, the optimal time to be put on antiretroviral treatment still remained uncertain [2,3]. With the improved knowledge of HIV and AIDS by the health sector in general, however, more definite proposals were made including putting anyone whose CD4 count dropped to 350 cells/mm 3 on antiretroviral treatment prior to 2013, and having on treatment all people with the CD4 of 500 cells/mm 3 (WHO 2015) or worse.…”