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:
- The child is graded as having stage 3 or 4 HIV infection (i.e. moderate or severe clinical signs of HIV infection).
- 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’).