Antiretroviral therapy: when and what to start-- an American perspective.

The major US treatment guidelines now recommend starting antiretroviral therapy (ART) later in the course of HIV infection because of an increasing awareness of the difficulties associated with these regimens. Most of the data to support this change come from observational cohort studies. When deciding to start ART, several patient-specific factors and other issues should be considered. Because of the many choices for initial ART, clinicians should individualize the choice, taking into account regimen antiretroviral potency, durability, side effects, toxicities, and convenience to ensure a sustained clinical benefit for the patient.