Timing of Initiation of First-line Antiretroviral Therapy

  • Authors: Marshall J. Glesby, MD, PhD; Timothy J. Wilkin, MD, MPH (More Info)
  • Section Editor: Joel E. Gallant, MD, MPH
  • Editors in Chief: Daniel R. Kuritzkes, MD; Joseph J. Eron, Jr., MD
  • Last Reviewed: 4/1/16 (What's New)


  • Major cohort studies have consistently found that mortality is higher when ART is initiated at CD4+ cell counts < 200 cells/mm3 vs higher CD4+ cell counts[Egger 2002]
  • Cohort studies have reported inconsistent results on the benefits of ART initiation at higher CD4+ cell counts[May 2007; Kitahata 2009; Sterne 2009; CASCADE 2011; Marin 2009]
  • However, most cohort studies have reported increased life expectancy in patients initiating ART at higher CD4+ cell counts, with some cohort studies reporting life expectancy similar to the general population in some HIV-infected populations[van Sighem 2010; Lewden 2007]

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