Initiating ART
International guidelines now recommend ART initiation in all HIV-infected persons, regardless of CD4+ cell count, as a means of reducing disease progression and the future spread of HIV.1-3
Therapy should be initiated as soon as possible, however ART may be deferred on a case-by-case basis due to clinical and/or psychosocial factors. 1
Factors to consider when initiating or switching ART
Although the DHHS Guidelines recommend initiation of ART as soon as possible, various individual- and treatment-related factors need to be taken into consideration.1
Individual considerations1:
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Patient lifestyle and preference
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Baseline viral load and CD4 count
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Adverse effect profiles
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Comorbidities and coinfections (e.g. hyperlipidemia or osteoporosis)
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Hepatic and renal function
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Concomitant medications
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Adherence potential, both today and over the course of a lifetime
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Baseline resistance (e.g. HIV genotypic drug resistance test results and HLA-B*5701 status)
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Planned pregnancy
Treatment considerations1:
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Virologic efficacy
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Potential short- or long-term side effects
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Pill burden
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Dosing frequency
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Drug–drug interaction potential
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Cost
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Potential toxicity
The most appropriate ART regimen is one based upon assessment of the ease of adherence, tolerability and efficacy, according to current guidelines, while accounting for the individual’s wishes, context, lifestyle, comorbidities and other medications.
Treatment Guidelines
A summary of ART guidelines from the United States Department of Health and Human Services (DHHS).
Regimen Selection
Key considerations that can influence selection of a regimen.