What are the DHHS ART Guidelines on the initiation of antiretroviral therapy for HIV infection?

Updated: Apr 18, 2019
  • Author: R Chris Rathbun, PharmD, BCPS (AQ-ID), AAHIVP; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

The DHHS ART Guidelines recommend that therapy should be initiated in all persons living with HIV irrespective of CD4 count and viral load to decrease the risk for HIV disease progression, non-HIV-related morbidity and mortality, and to prevent transmission of HIV infection.  The decision to begin antiretroviral therapy, as well as the selection of the individual antiretroviral components, should be tailored to each patient, taking into account patient-specific variables and preferences.  The patient’s readiness and commitment to lifelong therapy should similarly be evaluated. Data from the START and TEMPRANO randomized trials have shown compelling evidence regarding the benefit of initiating ART at higher CD4-cell counts (>500 cells/mL), rather than deferring treatment until CD4-cell counts decline. [107, 108] Findings from these studies showed a lower rate of death or severe HIV-related illness (e.g., tuberculosis, Kaposi sarcoma, malignant lymphomas) in those who were treated early with ART compared to those that deferred treatment until a lower CD4 cell count was observed.


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