When to Start Antiretroviral Therapy in HIV-Infected Patients

HIV therapy is a rapidly changing field. One might hope that more than 30 years of intimate experience with a virus might leave us with a firm sense of precisely how to treat it. But HIV has largely eluded easy answers, and antiretroviral therapy continues to evolve dramatically almost from year to year.

As a result, seemingly simple questions -- such as "When do I start my patient on antiretroviral therapy?" -- don't have simple answers. In this interview, I was honored to discuss this most fundamental of HIV treatment questions, along with other related issues, with two of the world's leading HIV specialists: Joel Gallant, M.D., M.P.H., a professor of medicine and epidemiology at the Johns Hopkins University School of Medicine and the associate director of the Johns Hopkins AIDS Service; and Paul Sax, M.D., the clinical director of the HIV Program and the Division of Infectious Diseases at Brigham and Women's Hospital, as well as the editor-in-chief of Journal Watch HIV/AIDS Clinical Care.

Both men are currently members of the panel of experts that periodically revises the bible of HIV treatment in the U.S.: the Department of Health and Human Services (HHS) antiretroviral therapy guidelines for HIV-infected adults and adolescents.