Antiretroviral therapy (ART) has led to dramatical improvements in the
prognosis of people living with HIV. ART suppresses viral replication, reconstitutes
the immune system, decreases the possibility of many HIV-related complications, and
lowers the risk of HIV acquisition. Despite of substantial health benefits of ART, it
accompanies its own limits. ART does not cure HIV infection and needs taking several
medicines simultaneously. It causes numerous adverse effects, it is expensive and
efficacy requires complete adherence. Poor adherence leads to emergence of resistance
virus and finally treatment failure.
However ART is now recommended for everyone with HIV regardless of CD4 count
and stage of infection. Evidences in favor of earlier ART initiation include clinical
trials, better understanding of viral dynamics, effect of inflammation on body organs,
newer medications that are better tolerated, data derived from cohort studies, and public
health benefits of ART in preventing HIV transmission. Concerns about early ART
initiation include effect of long term ART toxicity, impact of possible ART nonadherence
on viral resistance, and feasibility of implementing early ART.
Based on currently existing evidences, ART is recommended for all HIV-infected
individuals. The suggestion is the strongest for people with lower counts of CD4 cells,
or for those with pregnancy, history of AIDS-defining illness, any type of tuberculosis,
acute opportunistic infections, HIV associated nephropathy, HBV co-infection and for
all children <2 years old.
Keywords: Antiretroviral drugs, Antiretroviral therapy, ART benefits, ART
feasibility, ART initiation, ART limitation, Early ART, Health benefits, Time of
ART initiation, Viral suppression.
