Why Everyone (Almost) with HIV Needs to Be on Treatment: A Review of the Critical Data

Infect Dis Clin North Am. 2019 Sep;33(3):663-679. doi: 10.1016/j.idc.2019.05.002. Epub 2019 Jun 24.


Since 2014, a consensus of landmark studies has justified starting antiretroviral therapy (ART) regardless of CD4 count. The evidence for immediate and universal ART is strong, clearly showing individual and population-level benefits, and is supported by all major guidelines groups. Altogether, improvements in ART and recognition of its clinical and epidemiologic benefits justify near-universal ART, preferably as soon after the diagnosis of human immunodeficiency virus (HIV) as possible. Case-based discussions provide a framework to explore the evidence behind the current recommendation for ART for all HIV-positive persons and specific scenarios are discussed in which ART initiation may be delayed.

Keywords: AIDS; Antiretroviral therapy; CD4; Guidelines; HIV; Rapid start; Treatment as prevention.

Publication types

  • Review

MeSH terms

  • Anti-Retroviral Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / methods*
  • Disease Transmission, Infectious / prevention & control*
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • Humans


  • Anti-Retroviral Agents