When to Start Antiretroviral Therapy

Antiretroviral therapy (ART) has led to dramatical improvements in the prognosis of people living with HIV. ART suppresses viral replication, reconstitutes the immune system, decreases the possibility of many HIV-related complications, and lowers the risk of HIV acquisition. Despite of substantial health benefits of ART, it accompanies its own limits. ART does not cure HIV infection and needs taking several medicines simultaneously. It causes numerous adverse effects, it is expensive and efficacy requires complete adherence. Poor adherence leads to emergence of resistance virus and finally treatment failure.

However ART is now recommended for everyone with HIV regardless of CD4 count and stage of infection. Evidences in favor of earlier ART initiation include clinical trials, better understanding of viral dynamics, effect of inflammation on body organs, newer medications that are better tolerated, data derived from cohort studies, and public health benefits of ART in preventing HIV transmission. Concerns about early ART initiation include effect of long term ART toxicity, impact of possible ART nonadherence on viral resistance, and feasibility of implementing early ART.

Based on currently existing evidences, ART is recommended for all HIV-infected individuals. The suggestion is the strongest for people with lower counts of CD4 cells, or for those with pregnancy, history of AIDS-defining illness, any type of tuberculosis, acute opportunistic infections, HIV associated nephropathy, HBV co-infection and for all children <2 years old.

Keywords: Antiretroviral drugs, Antiretroviral therapy, ART benefits, ART feasibility, ART initiation, ART limitation, Early ART, Health benefits, Time of ART initiation, Viral suppression.