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  • When should antiretroviral treatment start
    • When to start antiretroviral therapy

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    INTRODUCTION

    Epidemiologic data have demonstrated that combination antiretroviral therapy (ART) has led to remarkable declines in morbidity and mortality among persons with human immunodeficiency virus (HIV) [1-3].

    Initially, there was a "hit hard and hit early" approach to treatment, implying that all patients should be treated with combination therapy as soon as possible [4]. Some providers, however, withheld therapy in patients with relatively preserved CD4 counts given the toxicity and complexity of early ART and the lack of clinical evidence proving a benefit of therapy for those with normal CD4 counts.

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    • Definitive clinical trials and further advances in HIV therapy have shifted the risk-benefit ratio back to earlier treatment. The standard of care today is to treat nearly all HIV-infected individuals with ART, regardless of CD4 count.

    This topic will discuss when to initiate ART and will review the evidence supporting rapid initiation of therapy. The selection of specific medications and laboratory monitoring on treatment are discussed elsewhere.

    (See "Selecting antiretrov

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