International guidelines now recommend starting antiretroviral therapy (ART) in all HIV infected persons, regardless of CD4+ cell count, to reduce the risk of disease progression and to prevent transmission.1-4 The recommendations are based on findings from two large, randomised controlled trials that analysed the optimal time to initiate ART: START5 and TEMPRANO.6
There is a growing body of evidence to suggest that rapid initiation of – starting within seven days of HIV diagnosis – can provide sustained viral suppression and reduce transmission.
Early diagnosis and treatment of individuals with recently acquired HIV infection may alter the long-term course of the disease. The early antiretroviral treatment provides an opportunity to limit transmission at a time when most people are highly infectious. Furthermore, early treatment opens the door for individuals to receive an appropriate referral, support, and education.
While antiretroviral therapy (ART) is recommended for all people living with HIV, appropriate treatment strategies will vary based on individual needs. Recommendations for treatment initiation and switching, based on international guidelines, are provided here.
Goals of antiretroviral therapy
The goal of antiretroviral therapy (ART) is suppression of HIV replication to below the detection limits of clinical assays, and suppression at <50 copies/mL is the widely accepted target for ART success.
Maximal and durable viral suppression:
Preserves CD4 T-cell numbers.
Delays or prevents viral resistance.
Decreases inflammation and immune activation thought to contribute to higher rates of cardiovascular and other end-organ damage.
Reduces perinatal and behavior-associated onward transmission of HIV.