When to initiate ART: A review for clinicians and patients

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When to initiate antiretroviral therapy in HIV-1-infected adults: a

review for clinicians and patients

Evan Wood a c, S Hogg a b, P Harrigan a c and

Julio SG Montaner a c

The Lancet Infectious Diseases 2005; 5:407-414

DOI:10.1016/S1473-3099(05)70162-6

Summary

One of the most controversial topics in the medical management of

HIV disease is the optimal time to initiate highly active

antiretroviral therapy (HAART) in HIV-1-infected adults. Premature

exposure to antiretrovirals may precipitate early evolution of

resistance and unnecessary side-effects, whereas remaining off HAART

until late in the course of HIV disease may lead to reduced

therapeutic benefits and elevated mortality.

The lack of a randomised clinical trial to consider this issue has resulted in

ongoing revision of expert recommendations and substantial variability between

international consensus guidelines regarding the optimal time to initiate

therapy.

Since this uncertainty is a source of unease for both patients and clinicians,

we summarise the latest evidence regarding the optimal time to initiate HAART

with consideration of the potential benefits and drawbacks of starting HIV

treatment at the different levels presently recommended in leading consensus

guidelines.

Affiliations

a British Columbia Centre for Excellence in HIV/AIDS, St 's

Hospital, Vancouver, BC, Canada

b Department of Health Care and Epidemiology, University of British

Columbia, Vancouver

c Department of Medicine, University of British Columbia, Vancouver

Correspondence to: Professor Julio S G Montaner, AIDS Research

Program, University of British Columbia/St 's Hospital, 667–1081

Burrard Street, Vancouver, BC V6Z 1Y6, Canada. Tel +1 604 806 8036;

fax +1 604 806 8527