Initiating HIV therapy. Timing is critical, controversial

Currently available antiretroviral drug regimens are able to suppress HIV replication and allow CD4 recovery in the vast majority of patients with HIV infection. The challenge is to match each patient to the regimen that is most likely to durably suppress HIV replication enough to prevent resistance selection without causing treatment-limiting toxicities. It is also critical, but difficult, to know when to begin treatment relative to CD4 cell count and plasma viral load. In this article, Dr Volberding addresses the central questions surrounding antiretroviral treatment initiation and reviews some available treatment options.