What are the indications for initiating antiretroviral therapy in patients with newly diagnosed AIDS?

Indications for initiating antiretroviral therapy (ART) in patients with newly diagnosed acquired immunodeficiency syndrome (AIDS) include all patients regardless of CD4 count, with particular urgency in those presenting with AIDS-defining illnesses or low CD4 counts. UK guidelines recommend starting ART immediately upon diagnosis of AIDS to reduce morbidity and mortality, improve immune function, and decrease HIV transmission risk ¹. This approach aligns with evidence supporting early initiation of ART even in asymptomatic patients, as delaying treatment can lead to disease progression and opportunistic infections (Khalsa, 2006). Specifically, ART should be initiated in patients with AIDS-defining conditions, such as Pneumocystis jirovecii pneumonia or Kaposi’s sarcoma, and in those with CD4 counts below 350 cells/mm³, with many guidelines now advocating treatment regardless of CD4 count due to improved outcomes ¹ (Khalsa, 2006). Additionally, ART initiation is critical in patients with high viral loads or symptomatic HIV infection to control viral replication and restore immune competence ¹ (Khalsa, 2006).

In summary, the primary indication for starting ART in newly diagnosed AIDS patients is the diagnosis itself, with emphasis on early treatment to prevent further immune deterioration and opportunistic infections.