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.
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