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.
- Daar ES, Pilcher CD and Hecht FM. Clinical presentation and diagnosis of primary HIV-1 infection. Curr Opin HIV AIDS. 2008, 3:10-15.
- Hammer SM. Management of Newly Diagnosed HIV Infection. N Enlg J Med. 2005, 353:1702-1710.
- 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.