Early versus Standard Antiretroviral Therapy for HIV-Infected Adults in Haiti

The optimal time to initiate antiretroviral therapy in HIV-infected adults, especially in resource-poor areas, is debated. In this study of HIV-infected adults in Haiti, the investigators found that when antiretroviral therapy was initiated when the CD4 count was greater than 200 and less than 350 per cubic millimeter, as compared with waiting until the CD4 count fell to 200 per cubic millimeter or less, the rate of death was decreased, as was the rate of incident tuberculosis. Investigators found that when antiretroviral therapy was initiated when the CD4 count was greater than 200 and less than 350 per cubic millimeter, as compared with waiting until the CD4 count fell to 200 per cubic millimeter or less, the rates of death and of incident tuberculosis were decreased. The optimal time to initiate antiretroviral therapy in adults who are infected with human immunodeficiency virus (HIV) remains uncertain. There have been no randomized trials to determine the optimal time to start antiretroviral therapy in adults who have CD4+ T-cell counts that are greater than 200 and less than 350 per cubic millimeter. Furthermore, there are few data on the optimal time to start antiretroviral therapy in persons who live in locations with limited resources, where high rates of tuberculosis, malnutrition, and coinfection with tropical diseases may alter the natural history of HIV disease and the optimal time to initiate . . .