1
Table 1. Indications for Initiating Antiretroviral Therapy
Clinical Condition and/or CD4 Count Comments
ART is recommended for all HIV-infected
individuals. e strength and evidence for this
recommendation vary by pretreatment CD4 count:
• CD4 count <350 cells/mm
3
(AI)
• CD4 count 350–500 cells/mm
3
(AII)
• CD4 count >500 cells/mm
3
(BIII)
Patients starting ART should be
willing and able to commit to lifelong
treatment and should understand the
benefits and risks of therapy and the
importance of adherence (AIII).
Patients may choose to postpone
therapy, and providers may elect to
defer therapy, based on clinical and/or
psychosocial factors, on a case-by-case
basis.
ART also is recommended for HIV-infected
individuals for the prevention of transmission of
HIV. e strength and evidence for this
recommendation vary by transmission risks:
• Perinatal transmission (AI)
• Heterosexual transmission (AI)
• Other transmission risk groups (AIII)
Table 2. Coinfections
Disease Recommendation
Hepatitis B When treatment is indicated, use an ART regimen containing either
tenofovir and emtricitabine OR tenofovir and lamivudine.
Hepatitis C Consider ART regardless of CD4 count. If CD4 >500, may defer ART
until aer HCV therapy. If CD4 <200, start ART and defer HCV
therapy until aer CD4 increase.
Tuberculosis
(TB)
The presence of active TB requires immediate
a
initiation of treatment (AI).
• Include a rifamycin (rifabutin preferred) in regimens for patients
receiving ART, with dosage adjustment if necessary (AII).
Patient Status CD4 (cells/mm
3
) Initiate ART
All <50 ≤2 wk after TB Rx (AI)
Severe
a
50–200 2–4 wk after TB Rx (BI)
>200 2–4 wk after TB Rx (BIII)
Not severe 50–500 2–12 wk after TB Rx (AI)
>500 2–12 wk after TB Rx (BIII)
Pregnant – As early as feasible (AIII)
MDR/XDR TB – 2–4 wk after confirmed Dx
of resistance and initiation of
2nd-line TB therapy (BIII)
a
By clinical evaluation (including low Karnofsky score, low body mass index [BMI], low
hemoglobin, low albumin, organ system dysfunction, or extent of disease).
Assessment and Diagnosis
