Antiretroviral therapy: when to start and which drugs to use

US guidelines for treating HIV infection now advocate antiretroviral therapy (ART) for all HIV-infected patients who have CD4(+) T-cell counts less than 350 cells/muL. Treatment is recommended for all pregnant women and patients with AIDS-defining illnesses. At least one major guideline recommends ART for all patients with HIV--associated symptoms. Current first-line treatment for ART-naïve individuals consists of a combination of three agents: two nucleoside reverse transcriptase inhibitors plus either one ritonavir-boosted protease inhibitor or one nonnucleoside reverse transcriptase inhibitor (NNRTI). Although first-line therapies for HIV-infection provide excellent rates of virologic control, ART toxicities remain a challenge.