# Treatment should be started before CD4 cell count decreases to less than 350/μL, based on review of new data and considerations.
# Deciding whether to start treatment in patients with a CD4 cell count of 350 cells/μL or more should be individualized based on the presence of comorbidities, risk factors for progression to AIDS and non-AIDS diseases, and patient willingness to begin treatment.
# As noted in previous guidelines, factors prompting treatment initiation are a high plasma viral load (>100,000 copies/mL) and rapidly decreasing CD4 cell count (>100/μL per year).
# Newly recognized factors prompting earlier treatment initiation are active hepatitis B or C virus coinfection, cardiovascular disease risk, and HIV-associated nephropathy.
# The initial regimen must be individualized, particularly when there are comorbid conditions.
# The initial treatment regimen typically includes efavirenz or a ritonavir-boosted PI plus 2 NRTIs (tenofovir/emtricitabine or abacavir/lamivudine).
# Treatment failure should be promptly identified and managed.
# Even in heavily pretreated patients, the goal of treatment is an HIV-1 RNA level below assay detection limits.
* The initial treatment regimen for HIV infection must be individualized, particularly in patients with comorbid conditions, but typically includes efavirenz or a ritonavir-boosted PI plus 2 NRTIs (tenofovir/emtricitabine or abacavir/lamivudine). Even in heavily pretreated patients, the goal of treatment is an HIV-1 RNA level below assay detection limits. Treatment failure should be promptly identified and managed.
* Treatment should be started before CD4 cell count decreases to less than 350/μL. Factors prompting treatment initiation are a high plasma viral load (>100,000 copies/mL), rapidly decreasing CD4 cell count (>100/μL per year), active hepatitis B or C virus coinfection, cardiovascular disease risk, and HIV-associated nephropathy.
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