GIM Question 23 Instructor

What are the indications for initiating anti-retroviral therapy initiation in patients with HIV?
The decision to begin antiretroviral therapy in an HIV+ patient depends on the presence of one or more of the following:

• CD4 count <350 (recent evidence suggests possibly starting therapy when CD4 count is between 350-500)
• Annual decline in CD4 count is >100 cells/mm³
• Plasma HIV-1 RNA level (“viral load”) is > 100,000 copies/mL
• Patient exhibits signs/symptoms of acute HIV infection: fever, myalgia, rash, fatigue, headache, pharyngitis, cervical adenopathy, arthralgia, night sweats, diarrhea
• Co-infection with PJP, Mycobacterium avium complex, or oral thrush

An infectious disease specialist should be consulted when initiating antiretroviral therapy.

Resources

1. Daar ES, Pilcher CD and Hecht FM. Clinical presentation and diagnosis of primary HIV-1 infection. Curr Opin HIV AIDS. 2008, 3:10-15.
2. Hammer SM. Management of Newly Diagnosed HIV Infection. N Enlg J Med. 2005, 353:1702-1710.
3. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.