A 35-year-old man newly diagnosed with HIV has CD4 count 180 cells/μL and HIV RNA 85,000 copies/mL. He has no prior ART exposure. According to current WHO 2024 and DHHS 2024 guidelines, regarding timing of ART initiation:

• A Defer ART until CD4 < 100 cells/μL to avoid immune reconstitution inflammatory syndrome
• B Start ART immediately (same day or within days) regardless of CD4 count, using a recommended first-line regimen ✓
• C ART should begin only after opportunistic infection prophylaxis is established for 4 weeks
• D ART is deferred until HIV RNA > 100,000 copies/mL

Explanation

Current WHO 2024 and DHHS 2024 guidelines recommend immediate ART initiation (same day or within 7 days of diagnosis) for all HIV-positive individuals, regardless of CD4 count or viral load, provided the patient is ready. This is supported by the START trial (early ART reduced AIDS and non-AIDS events) and HPTN 052 (reduces transmission). The preferred first-line regimen per WHO 2024 is dolutegravir-based (DTG + TDF + 3TC or DTG + 3TC). Exceptions include active cryptococcal meningitis (delay ART 4–6 weeks after antifungal induction) and TB meningitis (delay ART 4 weeks after TB therapy).

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.