Indications for Initiating Antiretroviral Therapy in Resource-Limited Settings

Last updated June 10, 2014
Case Authors: 
Christopher B. Behrens, MD
Clinical Associate Professor
Department sof Global Health and Medicine
University of Washington School of Medicine 
Learning Objectives: 
  1. Describe indications for initiation of antiretroviral therapy as described in the 2010 WHO Guidelines on Antiretroviral Therapy in Resource-Limited Settings.
  2. Describe major differences between the latest WHO Guidelines regarding initiation of therapy as compared with prior WHO Guidelines.

Display Group

  1. World Health Organization, UNAIDS, UNICEF. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Progress report 2010.
  2. World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents: Recommendations for a public health approach: 2010 revision. WHO, 2010.
  3. Siegfried N, Uthman OA, Rutherford GW. Optimal time for initiation of antiretroviral therapy in asymptomatic, HIV-infected, treatment-naive adults. Cochrane Database Syst Rev. 2010;:CD008272.
  4. Severe P, Juste MA, Ambroise A, et al. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. N Engl J Med. 2010;363:257-65.
  5. Strategies for Management of Antiretroviral Therapy (SMART) Study Group, Emery S, Neuhaus JA, Phillips AN, et al. Major clinical outcomes in antiretroviral therapy (ART)-naive participants and in those not receiving ART at baseline in the SMART study. J Infect Dis. 2008;197:1133-44.
  6. Strategies for Management of Antiretroviral Therapy (SMART) Study Group, Lundgren JD, Babiker A, El-Sadr W, et al. Inferior clinical outcome of the CD4+ cell count-guided antiretroviral treatment interruption strategy in the SMART study: role of CD4+ Cell counts and HIV RNA levels during follow-up. J Infect Dis. 2008;197:1145-55.
  7. When To Start Consortium, Sterne JA, May M, Costagliola D, et al. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009;373:1352-63.
  8. Kitahata MM, Gange SJ, Abraham AG, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med. 2009;360:1815-26.