From the Research
Antiretroviral therapy (ART) should be initiated in all individuals diagnosed with HIV regardless of CD4 count, as recommended by the European AIDS Clinical Society (EACS) guidelines. The most recent and highest quality study, 1, supports this recommendation, emphasizing the importance of starting treatment as soon as possible after diagnosis to prevent disease progression, reduce transmission risk, and preserve immune function.
Key Considerations for ART Initiation
- The recommended first-line regimen typically consists of an integrase strand transfer inhibitor (INSTI) such as dolutegravir, bictegravir, or raltegravir combined with two nucleoside reverse transcriptase inhibitors (NRTIs), commonly tenofovir (either TDF or TAF) and emtricitabine or lamivudine.
- Baseline resistance testing should be performed to guide regimen selection, along with assessment of comorbidities, potential drug interactions, and patient preferences to ensure optimal adherence.
- For patients with advanced disease (CD4 count <200 cells/μL), opportunistic infection prophylaxis should be considered alongside ART initiation.
Importance of Rapid ART Initiation
The guidelines emphasize the importance of rapid ART initiation, ideally within days of diagnosis, as this approach has demonstrated improved retention in care and better virological outcomes, as supported by 1. Treatment readiness assessment and adherence support are crucial components of successful therapy, as consistent medication adherence is essential for viral suppression and preventing drug resistance.
Additional Considerations
- The use of dolutegravir and lamivudine as a two-drug regimen has shown promise in terms of efficacy and barrier to resistance, as discussed in 2.
- Other studies, such as 3 and 4, provide additional insights into the effectiveness of different ART regimens, but the primary recommendation remains to initiate ART as soon as possible after diagnosis, regardless of CD4 count.