title: Community views: balancing the public health benefits of earlier antiretroviral treatment with the implications for individual patients - perspectives from the community.
abstract: OBJECTIVE
  When should people with HIV start treatment? This question is widely debated. The recent momentum to initiate treatment at a CD4 cell count above 350 cells/mm3 is driven by the potential population benefits of antiretroviral treatment reducing infectiousness together with operational concerns. These are important. However, we focus on the clinical benefits and risks for the person taking treatment, and how this may vary depending on the background health setting.
  
  
  RESULTS
  We refer to the recent guideline changes and the limited evidence on which they are based. Many studies that have informed guideline changes reference plausible benefits, but have limited follow-up and are not designed to assess the potential risks. We note historical examples to show that expert opinion in the absence of data warrants caution.
  
  
  CONCLUSIONS
  Results from well powered studies designed to look at the question of when to start treatment are essential for quantifying the benefits and risks of earlier treatment. Meanwhile, the decision of when to start must be taken by the HIV-positive person in consultation with their health worker based on accurate information. That choice will vary depending on a person's individual health, their reason to want to treat and the resources of the health-care facility.
authors.affiliation: aHIV i-Base, London, UK bCentre for Social Science Research (CSSR), University of Cape Town, Cape Town, South Africa.
authors.forename: Simon
authors.initials: S
authors.lastname: Collins
authors.forename: Nathan
authors.initials: N
authors.lastname: Geffen
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D011634:Public Health; D011788:Quality of Life; D018570:Risk Assessment
chemical_list: D044966:Anti-Retroviral Agents