When to Start Therapy:
| Clinical State | | CD4 + T-cell Count & Viral Load | | Recommendation |
| Symptomatic (Sick: AIDS, thrush, unexplained fever) |
Any level |
Treat |
| Asymptomatic (no symptoms) |
T-cells below 500/ml or viral load above 10,000 (bDNA) or above 20,000 (RT-PCR) |
Treatment optional* |
| Asymptomatic |
T-cell above 500/ml and viral load is below 10,000 (bDNA) or below 20,000 (RT-PCR) |
Many doctors would delay; some would treat and abserve. |
* Some experts observe patients with 350-500 T-cells and viral-load levels below 10,000 (by bDNA) or below 20,000 (by RT-PCR).
(+) Federal HHS guidelines are created by doctors, researchers, and industry representatives. They differ slightly from recent International AIDS Society guidelines created only by doctors. IAS guidelines say HAART treatment should begin when viral load is 5,000-10,000, regardless of T-cell count. To get the full HHS guidelines, call 800-458-5231 or download from www.cdcnpin.org.
When to Interrupt Therapy: There are reasons such as drug interactions or pregnancy that may lead you to delay or interrupt HIV therapy. If you stop, stop all anti-HIV drugs at the same time to reduce the risk of developing drug-resistant HIV.
When to Change Therapy: There are several reasons to consider changing a drug regimen, including drug failure, poor absorption, adherence problems, and serious drug toxicity. Bad side effects are a good reason to substitute one or more drugs from the same class (replace AZT with d4T to avoid anemia, for example). If your regimen is failing, a drug-resistance test (see diagnostic tests) may help you determine why a given drug regimen is failing and help you select an alternative regimen. Consider changing your regimen when:
- Viral load does not fall below "undetectable" level within 4-6 months of HAART.
- Viral load is reduced by less than tenfold after eight weeks of HAART. If absorption appears normal and a person is adhering to the regimen, change in therapy is warranted.
- Viral load increases ("rebounds") to above the level of detection after becoming "undetectable."
- Viral load increases threefold or more above the lowest measurement.
- CD4 T-cell count continues to fall.
- Clinical symptoms of HIV disease develop or get worse.
- When switching: change at least two drugs in your regimen. Ideally, a new regimen should include at least two new drugs that you've never taken before.
When to Delay or Defer Therapy: Since HIV can become resistant to all HIV drugs, your initial and secondary treatment choices may limit future treatment options. Deferring treatment is an option for those with high, stable T-cell counts, but it's important to get regular medical checkups and monitor your health with viral-load and T-cell tests. If a person is clinically stable, has a detectable viral load, and possesses no good options for changing therapy, it may be best to delay changing therapy in the hope that better drugs will be available in the future.
