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)

Supporting Assets

Table 1 | Table 2 | Table 3 | Table 4

Table 1. DHHS: Changing Criteria for Initiation of ART

CD4+ Counts, cells/mm3

1998

2001

2006

2008

2009

2012

> 500

Offer if HIV-1 RNA > 20,000 copies/mL

Offer if HIV-1 RNA
> 55,000 copies/mL

Consider if HIV-1 RNA ≥ 100,000 copies/mL

Consider in certain groups*

Consider

Treat

350-500

Offer if HIV-1 RNA > 20,000 copies/mL

Consider if HIV-1 RNA > 55,000 copies/mL

Consider if HIV-1 RNA ≥ 100,000 copies/mL

Consider in certain groups*

Treat

Treat

200-350

Offer if HIV-1 RNA > 20,000 copies/mL

Offer, but controversy exists

Offer after discussion with patient

Treat

Treat

Treat

< 200 or symptomatic disease

Treat

Treat

Treat

Treat

Treat

Treat

*Includes pregnant women, patients with HIV-associated nephropathy, and patients with hepatitis B virus infection that requires treatment for which there is a definite recommendation to initiate therapy. Other considerations include certain acute opportunistic infections, rapidly declining CD4+ cell counts (> 100 cells/mm3/year), and higher HIV-1 RNA (> 100,000 copies/mL).
50% of panel members recommended starting ART at this CD4+ cell count level; the other 50% of members viewed treatment at this level as optional.

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