At what viral load and CD4 count level would ART be recommended?

The decision to initiate antiretroviral therapy (ART) in HIV-infected individuals is based on various factors, including viral load and CD4 count levels. The current guidelines provided by the World Health Organization (WHO), the United States Department of Health and Human Services (DHHS), and the European AIDS Clinical Society (EACS) recommend ART initiation in different scenarios based on viral load and CD4 count.

According to the 2021 WHO guidelines, ART should be offered to all people living with HIV, irrespective of their clinical stage, CD4 count, or viral load. This is known as the "treat all" approach and aims to achieve early viral suppression, reduce HIV transmission, and improve individual health outcomes.

In the DHHS and EACS guidelines, the specific viral load and CD4 count levels at which ART is recommended may vary slightly. Here's a general overview:

1. Viral Load of 100,000 Copies/mL or Higher:

- Regardless of the CD4 count, if an HIV-infected individual has a viral load of 100,000 copies/mL or higher, ART is typically recommended. A high viral load indicates a high level of HIV replication and increased risk of disease progression.

2. CD4 Count Below 350 Cells/µL:

- If the CD4 count drops below 350 cells/µL, ART is generally advised, irrespective of the viral load. A CD4 count below 350 cells/µL signifies impaired immune function and an increased risk of opportunistic infections and other complications.

3. Additional Factors:

Besides viral load and CD4 count, other factors may influence the decision to initiate ART, such as individual preferences, co-infections, pregnancy, and previous ART history.

Please note that these guidelines are subject to regular updates and may be modified in the future. For the most current recommendations, refer to the official guidelines provided by WHO, DHHS, or EACS. Consulting with a healthcare provider experienced in HIV management is crucial for making informed decisions regarding ART initiation.