Indications for Starting ART

Clinical and Patient Indications for Starting HIV Treatment

Feb 22, 2009

Starting an HIV patient on antiretroviral treatment requires them to be ready both clinically and mentally. The decision should be made by both the patient and provider.

The decision to start an HIV patient on antiretroviral therapy (ART) is one that is made by both the patient and the physician. Since resistance can develop if a patient does not continually take the medications in the prescribed manner, it is important that the patient is ready to begin the regimen.

Another concern when starting ART is that there are a number of serious side effects that can develop as a result of the treatment. There is also a risk of resistance developing as a result of long-term treatment. These two effects of ART can limit future treatment options. These problems make it very important for the physician and patient to ensure that ART is started at the appropriate time.

Clinical Criteria for Starting ART

There are a number of clinical indications for starting an HIV patient on ART. First, if a patient’s CD4 cell count is less than 200mm3 then the patient universally qualifies to start ART. Currently, most professionals are recommending that if an HIV patient’s CD4 cell count is below a 350 mm3 they should consider starting ART.

Another guideline for physicians is the development of an AIDS defining opportunistic infection. Finally, many physicians recommend that a patient should consider starting ART if they have a viral load of 50,000-100,000 c/mL, even if the patient’s CD4 cell count is higher than 350mm3.

Patient Considerations for Starting ART

In addition to clinical guidelines, it is important for a physician to determine whether a patient is ready to start ART. While it is important to start patients on ART in a timely fashion, it is never an emergency. It is important to ensure that the patient is ready before beginning a regimen.

It is recommended that patients never begin treatment on a first visit to a clinic. Health care providers should spend plenty of time educating the patient on how to take the medication, the importance of taking the medication properly, and possible side effects of the disease. Asking open-ended questions to ensure that the patient fully understands the material is important.

It is also important for providers to discuss issues of stigma with patients before starting them on ART. Patients may be required to take medication in front of other people, causing them to ask questions. Patients should be prepared to answer questions in a simple and comfortable fashion.

Finally, patients should understand the possible side effects of ART. If patients know the possible side effects and how to treat them they are less likely to stop taking their medication. Patients should know that they can always ask questions and discuss other possible regimens if the side-effects are too overwhelming.

The copyright of the article Indications for Starting ART in Aids/HIV Treatment is owned by Jamie Robertson. Permission to republish Indications for Starting ART in print or online must be granted by the author in writing.