A 32-year-old man newly diagnosed with HIV infection has CD4 count 410 cells/μL and viral load 42,000 copies/mL. He has no active opportunistic infections. Which statement about antiretroviral therapy initiation is MOST accurate per current WHO/DHHS guidelines?

• A ART should be deferred until CD4 falls below 350 cells/μL
• B ART should be initiated immediately regardless of CD4 count ✓
• C ART initiation depends on HIV RNA viral load only
• D Start ART only if the patient has symptomatic disease or AIDS-defining illness

Explanation

Current WHO 2023 and DHHS guidelines recommend immediate ART initiation for all people living with HIV, regardless of CD4 count or viral load. The START trial (2015) demonstrated a 57% reduction in serious illness or death in immediate vs deferred therapy even with CD4 >500. Immediate ART reduces transmission, preserves immune function, and prevents AIDS-defining complications. There is no longer a threshold CD4 count below which ART is deferred in treatment-naive patients.

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

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Written and medically reviewed by the StethoPrep medical team.