Quand et comment commencer un traitement antirétroviral chez l'adulte infecté par le VIHÂ ?

The goal of antiretroviral therapy is to achieve a plasma viral load < 50 copies/ml and a CD4 count > 500/mm3. In symptomatic patients (Class B and C of CDC classification 1993) and in asymptomatic patients with CD4 counts < 350/mm3, antiretroviral therapy should be started immediately, taking into account concurrent treatment of opportunistic infections and possible drug-drug interactions. In asymptomatic patients monitored regularly, it is recommended to start antiretroviral therapy when CD4 count is between 350 and 500/mm3. In asymptomatic patients with CD4 counts > 500/mm3, data are insufficient to recommend systematic introduction of antiretroviral therapy. The first antiretroviral treatment should be a triple therapy with two NRTIs with either an NNRTI or a boosted PI. Triple therapy with NNRTI should be tenofovir/emtricitabine + efavirenz. HAART with boosted PI may combine either tenofovir/emtricitabine or abacavir/lamivudine with atazanavir/r, darunavir/r or lopinavir/r.