When to Start Antiretroviral Therapy for HIV

Although we know HIV-positive patients with CD4 counts ≤200 cells/mm³ benefit from antiretroviral therapy, practice guidelines differ on when patients with higher counts should begin receiving these drugs. The best time has been difficult to establish precisely in part because benefits and harms from ART can accrue long after the usual follow-up periods that are assessed in clinical trials. Using data primarily from a cohort of veterans, researchers developed a computer simulation model to project the long-term effects of ART initiation at varying ages, CD4 counts, and viral loads.

In 50-year-old patients, regardless of viral load (10,000–300,000 copies/mL), ART initiation at a CD4 count of 200 cells/mm³ maximized life expectancy and quality…