Chronic HIV Infection | Indications for Starting Antiretroviral Therapy

 

Parameters:

(1) signs or symptoms of AIDS or severe HIV disease

(2) quantitative CD4 lymphocyte count

(3) plasma HIV RNA assay (branched chain DNA or RT-PCR)

Symptoms	CD4	HIV RNA	Recommendation
Yes	NA	NA	Treat
No	< 200 per µL	NA	Treat
No	>= 200 and < 350 per µL	NA	Treat may be offered but controversial
No	>= 350 per µL	> 55,000 copies per mL	Some experts would recommend starting therapy. Some would defer therapy and monitor CD4 levels more frequently. Untreated patients have a > 30% risk of developing AIDS in 3 years.
No	>= 350 per µL	<= 55,000 copies per mL	Many experts would defer therapy and observe. Untreated patients have a < 15% chance of developing AIDS.

 

Benefits of early therapy:

(1) Control of viral load is easier to achieve and maintain.

(2) Less risk of developing antiretroviral drug resistance if viral load is undetectable.

(3) Delay or prevent weakening of the immune system.

 

Risks of early therapy:

(1) Risk of drug toxicities.

(2) Risk of antiretroviral drug resistance if viral load is detectable.

(3) May limit future drug therapy options.

(4) Negative impact of drug therapy regimens on the patient's quality of life.

 

Benefits of delayed therapy:

(1) Avoids negative impact of drug therapy regimens on the patient's quality of life.

(2) Avoids drug toxicities.

(3) Reduced risk of antiretroviral drug resistance.

(4) Future drug therapy options preserved.

 

Risks of delayed therapy:

(1) Possibility of permanent damage to the immune system caused by the HIV.

(2) Possible difficulty in controlling viral load.