Page 53 - HIV/AIDS Guidelines

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infection, 151 the median CD4 count of newly diagnosed patients remains in the ~200 cells/mm range. The
exception is pregnant women diagnosed during prenatal care, who have a much higher median initial CD4
count. Compared with other groups, nonwhites, IDUs, and older patients more often receive a delayed
diagnosis of HIV infection and a substantial proportion of these individuals develop AIDS-defining illnesses
within 1 year of diagnosis. 147-150 Therefore, for the current treatment guidelines to have maximum impact,
routine HIV screening per current CDC recommendations is essential. It is also critical that all newly
diagnosed patients be educated about HIV disease and linked to care for full evaluation, follow-up, and
management. Once patients are in care, focused effort is required to retain them in the health care system if
the full benefits of early diagnosis and treatment are to be achieved both for the infected individuals and their
sexual partners.

Conclusion
The current recommendations are based on greater evidence supporting earlier initiation of ART than was
advocated in previous guidelines. The strength of the recommendations varies according to the quality and
availability of existing evidence supporting each recommendation. In addition to the benefit of earlier
initiation of therapy for the health of the HIV-infected individual, the reduction in sexual transmission to
HIV-uninfected individuals provides further reason for earlier initiation of ART. The Panel will continue to
monitor and assess the results of ongoing and planned randomized clinical trials and observational studies,
which will provide the Panel with additional guidance to form future recommendations.

References

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with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical
Trials Group 320 Study Team. N Engl J Med. Sep 11 1997;337(11):725-733.
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with acute opportunistic infections: a multicenter randomized strategy trial. PLoS One. 2009;4(5):e5575.
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8. Palella FJ, Jr., Deloria-Knoll M, Chmiel JS, et al. Survival benefit of initiating antiretroviral therapy in HIV-infected
persons in different CD4+ cell strata. Ann Intern Med. Apr 15 2003;138(8):620-626.
9. Cain LE, Logan R, Robins JM, et al. When to initiate combined antiretroviral therapy to reduce mortality and AIDS-
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10. Severe P, Juste MA, Ambroise A, et al. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. N
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11. Kitahata MM, Gange SJ, Abraham AG, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N
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