When to Initiate ART?

Initiating ART when CD4 counts were >350 cells/mm³ rather than <250 cells/mm³ was associated with lower risks for opportunistic disease, death, and other adverse events.

Current guidelines recommend starting antiretroviral therapy (ART) for asymptomatic HIV-infected patients only when the CD4 count is ≤350 cells/mm³. However, no randomized trials have been conducted during the era of potent ART to readdress this issue.

In the SMART study (Journal Watch Infectious Diseases Nov 29 2006), 5472 HIV-infected patients with CD4 counts >350 cells/mm³ were randomized to a viral-suppression group (VS; immediate initiation or reinitiation of ART; continuous ART thereafter) or a drug-conservation group (DC; therapy started at CD4 counts <250 cells/mm³ and discontinued at counts >350 cells/mm³). To assess the benefit of immediate versus deferred therapy, investigators recently analyzed the outcomes of a subgroup of SMART…

Reviewing Author

Daniel J. Diekema, MD, MS

When to Initiate ART?

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Reviewing Author