When to Start Antiretroviral Therapy — Ready When You Are?

The optimal time to start antiretroviral therapy in asymptomatic patients has been one of the central controversies in the care of patients with the human immunodeficiency virus (HIV) since the introduction of the first antiretroviral agent, zidovudine, more than two decades ago.1 Since then, periods of enthusiasm for aggressive early intervention2 have been followed by a more cautious approach.3 This slowly swinging pendulum has been pushed back and forth by the extraordinary benefits of antiretroviral therapy on one side4 and emerging data on its adverse effects on the other.5 The absence of a controlled, prospective study comparing early and deferred . . .