Why Everyone (Almost) with HIV Needs to Be on Treatment: A Review of the Critical Data

Abstract

Since 2014, a consensus of landmark studies has justified starting antiretroviral therapy (ART) regardless of CD4 count. The evidence for immediate and universal ART is strong, clearly showing individual and population-level benefits, and is supported by all major guidelines groups. Altogether, improvements in ART and recognition of its clinical and epidemiologic benefits justify near-universal ART, preferably as soon after the diagnosis of human immunodeficiency virus (HIV) as possible. Case-based discussions provide a framework to explore the evidence behind the current recommendation for ART for all HIV-positive persons and specific scenarios are discussed in which ART initiation may be delayed.

Keywords: AIDS; Antiretroviral therapy; CD4; Guidelines; HIV; Rapid start; Treatment as prevention.