Hiv Optimising treatment for naive patients


 Asymptomatic (HIV tests)

 HIV-related new presentation


 Seroconversion illness

  HIV screening programmes / insurance medicals




 Medical in-patients

  General practice / dentist / private clinics




 Emergency care

  GUM / sexual health clinic





  Antenatal clinics


 TB centres



  Blood transfusion centres





   Addiction treatment





Since start of ART, increasing survival rates for people with HIV

Estimated survival for HIV patients from age 25 yearsHepatitis C coinfected patients excluded

Adapted from Lohse N et al. 16th IAC 2006, Toronto, Canada. Abstract MOPE0310 

Decisions made when starting therapy need to be individualised

Starting therapy vs. deferring therapy

 Deferring Therapy

Starting Therapy

 Avoid negative effects on QoL

 Earlier suppression of viral replication

 Avoid drug-related toxicities

 Preserve immune function

 Preserve treatment options

 Prolong disease-free survival

Delay development of resistance

 Lower risk of detrimental viral evolution

Time for patient to understand treatment demands Possible decrease in the risk of HIV transmission

Less chance of treatment fatigue