When is the best time to initiate antiretroviral therapy?

Abstract

The benefit of antiretroviral therapy (ART) in reducing AIDS-related morbidity is indisputable 1 Mocroft A Vella S Benfield TL et al. for the EuroSIDA Study GroupChanging patterns of mortality across Europe in patients infected with HIV-1. Lancet. 1998; 352: 1725-1730 Summary Full Text Full Text PDF PubMed Scopus (1187) Google Scholar but tempered by toxic effects, difficulties with adherence, and viral resistance. Inconsistent findings of observational studies and scant definitive evidence from randomised trials have resulted in discrepant recommendations by guideline panels during past decades. 2 De Cock KM El-Sadr WM When to start ART in Africa: an urgent research priority. N Engl J Med. 2013; 368: 886-889 Crossref PubMed Scopus (58) Google Scholar Comparative effectiveness of immediate antiretroviral therapy versus CD4-based initiation in HIV-positive individuals in high-income countries: observational cohort studyThe benefits of immediate initiation of ART, such as prolonged survival and AIDS-free survival and increased virological suppression, were small in this high-income setting with relatively low CD4 count at HIV diagnosis. The estimated beneficial effect on AIDS is less than in recently reported randomised trials. Increasing rates of HIV testing might be as important as a policy of early initiation of ART. Full-Text PDF