When to start antiretroviral therapy.
The question of when to start combination antiretroviral therapy for treatment-naïve patients has always been controversial. This is particularly true in the current era, with major guidelines recommending very different treatment strategies. Despite a lack of clarity regarding the optimal time to begin therapy, there has been a recent shift toward earlier initiation. This more aggressive approach is driven by several observations. First, effective viral suppression with therapy can prevent non-AIDS-related morbidity and mortality. Second, therapy can prevent irreversible harm to the human immune system. Third, therapy may prevent transmission of HIV to others, and thus have a potential public health benefit. For patients who are motivated and willing to initiate early treatment, the collective benefits of early therapy may outweigh the well-documented risks of antiretroviral medications.
Jain
Vivek
V
HIV/AIDS Division, San Francisco General Hospital, University of California-San Francisco, San Francisco, CA 94110, USA. vivek.jain@ucsf.edu
Deeks
Steven G
SG
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality / Q000517:prevention & control; D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic
D019380:Anti-HIV Agents