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To the Editor: Considerable uncertainty and debate exist regarding the appropriate time for initiating antiretroviral therapy for the treatment of HIV (human immunodeficiency virus).¹ British guidelines suggest that treatment should be initiated based on CD4 cell count alone,² while US guidelines recommend treatment based on a CD4 cell count below 500/mm³ or a viral load above 10 000 to 20 000 per mL.^3-4 No prospective study of starting vs delaying the initiation of highly active antiretroviral therapy in patients with higher viral loads has been performed.

Methods

We retrospectively compared the outcomes of starting highly active antiretroviral therapy at varying CD4 cell counts and viral loads in a clinical cohort of HIV-infected patients in an ongoing study.⁵ Patients who were starting their first combination antiretroviral regimen with a protease inhibitor or nonnucleoside reverse transcriptase inhibitor after July 1, 1996, were analyzed. Only patients who received at least 6 months of combination antiretroviral therapy . . . [Full Text of this Article]

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