[Initial antiretroviral therapy in HIV-infected patients]

In 2014 an antiretroviral treatment should be initiated in any HIV-infected patient, whatever his/her CD4 lymphocyte count. The objectives of antiretroviral treatment are both individual (restoration or preservation of immune functions, decreased morbidity and mortality, decreased chronic systemic inflammation) and collective (decreased risk of HIV sexual transmission). Preferred initial regimens include two nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a third agent, either a non-nucleoside reverse transcriptase inhibitor (rilpivirine or efavirenz), or a ritonavir-boosted protease inhibitor (atazanavir or darunavir). Alternatively, the third agent may be chosen among integrase inhibitors (raltegravir, dolutegravir, elvitegravir/cobicistat). Immunologic and virologic response to first-line antiretroviral therapy should be monitored closely according to specific criteria and objectives.