Section 4: Initiating therapy
When to start ART?
Recommendations from guidelines
§ Treat in specific circumstances such as HCV/HBV coinfection, HIV-AN or other deficiency, VL >105 copies/mL, CD4 decline >50-100 cells/mm3 per year, >50 years, pregnancy, high CV risk or malignancy; † Generally defer treatment, closer follow up if VL >105 copies/mL . Treatment can be offered if presence of one or more of previous co-morbid conditions (CD4 350–500); *Consider treatment in specific groups such as AIDS diagnosis, HCV/HBV coinfection, low CD4 percentage, established or high risk of CVD, discordant couples; ‡ ART should be considered unless patient is an elite controller (HIV-1 RNA 50 copies/mL) or has stable CD4 cell count and low-level viremia in the absence of ART. 1. DHHS Guidelines 2011. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed March 2011; 2. EACS Guidelines 2011. Available at http://www.europeanaidsclinicalsociety.org/guidelinespdf/EACS-EuroGuidelines_FullVersion.pdf. Accessed March 2011; 3. Gazzard B et al., HIV Medicine 2008;9:563–608; 4. Thompson MA et al., JAMA 2010;304:321–333