Balancing adherence concerns with the risks of HIV disease progression.

The appropriate time to initiate antiretroviral therapy (ART) for HIV infection is an area of much debate and some scientific study. In the absence of opportunistic infection, HIV-related symptoms, pregnancy, or comorbidities that may trigger the use of ART (e.g., hepatitis B), treatment guidelines have focused primarily on the CD4 lymphocyte count and plasma HIV RNA level and have suggested immunologic and virologic thresholds for the initiation of ART [1, 2]. These thresholds are an attempt to balance the benefits of therapy with the limitations of therapy, the major limitations being the development of drug resistance and/or drug toxicity. The rapid development of new antiretroviral agents and the results of recent clinical trials that support higher rates of efficacy and lower toxicity with contemporary treatment regimens have led to recent changes in treatment guidelines, including recommendations to initiate ART at somewhat higher CD4 cell counts [1, 2]. Recent data also suggest that earlier initiation of ART may be beneficial in pre-