A 32-year-old man is newly diagnosed with HIV infection. CD4 count is 380 cells/µL and HIV viral load is 45,000 copies/mL. He has no active opportunistic infections. He is willing to start antiretroviral therapy. According to current WHO 2023 and DHHS guidelines, when should ART be initiated?

• A Wait until CD4 count falls below 200 cells/µL before starting ART
• B Start ART only if CD4 < 350 cells/µL or viral load > 100,000 copies/mL
• C Delay ART until viral tropism testing is completed to choose appropriate regimen
• D ART should be started as soon as possible in all treatment-naive patients regardless of CD4 count, ideally same-day or within 7 days of diagnosis ✓

Explanation

WHO 2023 and DHHS guidelines recommend immediate ART initiation (same-day or within 7 days) for all treatment-naive HIV-positive individuals regardless of CD4 count or viral load, provided no active TB or cryptococcal meningitis (START trial confirmed morbidity/mortality benefit of early treatment). Rapid ART initiation improves linkage to care and reduces transmission. Viral tropism testing is only required when CCR5 antagonists (maraviroc) are being considered.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.