Antiretroviral Therapy

Physicians use viral loads and T-cell/CD4+ counts as approximate guides for starting treatment. There are no magic numbers, but the International AIDS Society recommends antiretroviral therapy when:

• The patient has a symptomatic HIV infection, no matter what the test results are
• The viral load rises above about 30,000 copies/mL, no matter what the T-cell/CD4+ count is
• The T-cell/CD4+ counts fall below 350 x 106/L (350/ul), no matter what the viral load is
• The viral load is between 5000 and 30,000 copies/mL and the T-cell/CD4+ cell count is between 350 and 500 x 106/L

Patients with a viral load below 5000 copies/mL and a T-cell/CD4+ count above 500 x 106/L are at low risk for short-term (3 year) clinical progression of disease. Whether therapy should be started or not in these patients depends on potential side effects, the patient's willingness to adhere to the strict therapy regimen, and other factors such as health insurance coverage.

When antiretroviral drugs are effective, the viral load should decrease to an undetectable level within 30 to 90 days of initial treatment. The T-cell/CD4+ count should simultaneously increase, usually by about 100 cells/cc during the first year.