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)

Summary

Introduction

  • Advent of effective ART, known as HAART, strengthened the case for earlier treatment initiation throughout the late 1990s
    • Problematic toxicity, adherence, and risk of drug resistance tempered this enthusiasm
  • Current options for first-line ART are simpler, more effective, and less toxic than earlier therapies
  • Harmful effects of uncontrolled HIV replication and its association with key non–AIDS-defining conditions is well evidenced
  • These observations, key epidemiologic studies, and the potential prevention benefit have prompted several treatment guidelines to recommend ART initiation for all patients, including those with CD4+ cell counts > 500 cells/mm3 (Management Guidelines) (Management Guidelines) (Management Guidelines) (Management Guidelines) (Table 1, Table 2)[...

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