Overcoming Impediments to Global Implementation of Early Antiretroviral Therapy

Antiretroviral therapy (ART) has transformed the global response to the human immunodeficiency virus (HIV) epidemic by reducing the incidence of acquired immunodeficiency syndrome (AIDS)–related death and disease. However, when to start ART in asymptomatic persons has long been debated. Initial calls to “hit HIV early and hard” two decades ago1 were countered by the pragmatic prioritization of patients at highest risk for AIDS — namely, those with low CD4+ cell counts (≤200 cells per cubic millimeter). This threshold for ART initiation has been progressively increasing, first to 350 cells per cubic millimeter and most recently to 500 cells per cubic . . .