RECOMMENDATIONS FOR INITIATION OF THERAPY IN NAIVE HIV-INFECTED PATIENTS |
| Symptomatic |
- CDC stage B and C: treatment recommended
- If OI, initiate as soon as possible *
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| Asymptomatic |
- CD4 < 200: Treatment recommended, without delay.
- CD4 201-350: treatment recommended.
- CD4 350-500:
- Treatment recommended if hepatitis C co-infection, hepatitis B co-infection requiring therapy, HIV-associated nephropathy or other specific organ deficiency;
- Treatment should be considered if VL>105 c/ml and/or CD4 decline >50-100/mm3/year or age >50 or, pregnancy, high cardiovascular risk, malignancy.
- CD4 > 500:
- Treatment should generally be deferred, independently of plasma HIV RNA; closer follow-up of CD4 if VL > 105 c/ml.
- Treatment can be offered if presence of $ 1 of the above co-morbid conditions (CD4 350-500).
- Whatever CD4 and Plasma HIV RNA, treatment can be offered on an individual basis, especially if patient is seeking and ready for ARV therapy
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| Resistance testing |
Genotypic testing and subtype determination recommended, ideally at the time of HIV diagnosis, otherwise before initiation of first-line regimen
If genotypic testing is not available, a ritonavir-boosted PI should be included in the first-line regimen |
| Additional remarks |
- Before starting treatment, CD4 should be repeated and confirmed
- Time should be taken to prepare the patient, in order to optimize compliance and adherence **
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