When should antiretroviral treatment be started?

There remains a lot of debate as to when treatment should be started and guidelines are changing rapidly as more information becomes available. In South Africa, treatment is started when either:

  1. The child is graded as having stage 3 or 4 HIV infection (i.e. moderate or severe clinical signs of HIV infection).
  2. The CD4 percentage falls below 20% in asymptomatic children less than 18 months and below 15% if 18 months and older, or a CD4 count below 350 cells/μL in children of 5 years or more.

The clinical staging and CD4 percentage are used as indications for antiretroviral therapy.

The mother or carer must also be ready to accept the diagnosis and make a commitment to treatment (‘treatment-ready’).

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