When and how to start antiretroviral treatment in HIV-infected adults?

The goal of antiretroviral therapy is to achieve a plasma viral load < 50 copies/ml and a CD4 count > 500/mm(3). In symptomatic patients (Class B and C of CDC classification 1993) and in asymptomatic patients with CD4 counts < 350/mm(3), antiretroviral therapy should be started immediately, taking into account concurrent treatment of opportunistic infections and possible drug drug interactions. In asymptomatic patients monitored regularly, it is recommended to start antiretroviral therapy when CD4 count is between 350 and 500/mm(3). In asymptomatic patients with CD4 counts > 500/mm(3), data are insufficient to recommend systematic introduction of antiretroviral therapy. The first antiretroviral treatment should be a triple therapy with two NRTIs with either an NNRTI or a boosted PI. Triple therapy with NNRTI should be tenofovir/emtricitabine + efavirenz. HAART with boosted PI may combine either tenofovir/emtricitabine or abacavir/lamivudine with atazanavir/r, darunavir/r or lopinavir/r. (C) 2011 Published by Elsevier Masson SAS.