Indications for Initiating Antiretroviral Therapy for HIV-1 Infections

Clinical Category

CD4⁺ T-Cell

Count

Plasma HIV

RNA

Adult and Postpartum

Recommendation

Pregnancy

Recommendation

Symptomatic (AIDS or severe symptoms)

Any value

Any value

Treat

Treat

Asymptomatic AIDS

< 200/mm³

Any value

Treat

Treat

Asymptomatic

200-350/mm³

Any value

Treatment should be offered, although controversial

Treat

Asymptomatic

> 350/mm³

> 100,000/mL

Some recommend initiating therapy, recognizing that the 3-year risk for untreated patients to develop AIDS is > 30%; in the absence of increased levels of plasma HIV RNA, others recommend deferring therapy and monitoring the CD4⁺ T-cell count and HIV RNA level more frequently; outcome data with therapy are lacking

Treat

Asymptomatic

> 350/mm³

< 100,000/mL

Most recommend deferring therapy and monitoring CD4⁺ T-cell count, recognizing that the 3-year risk for untreated patients to develop symptomatic AIDS is < 15%

Treat

AIDS = acquired immunodeficiency syndrome; HIV = human immunodeficiency virus.

From U.S. Public Health Service (2004a, 2003); updated from http://AIDSinfo.nih.gov; accessed October 29, 2004.