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Ever since combination antiretroviral therapy (ART) transformed HIV into a chronic manageable disease, experts have debated the right time for patients to begin treatment. At first we delayed until patients got sick; then we waited for signs of serious immune depletion; then we began to prescribe medications for patients with even minimal immune depletion. The year 2015 saw the uniform recommendation that all HIV-positive people be treated immediately, regardless of duration of infection or immune status.
We have known for some time that patients who start treatment early often have better immunologic recovery than those who do not (NEJM JW Gen Med Jan 1 2015 and JAMA Intern Med 2015; 175:88). In 2015, we got invaluable clinical confirmation…