Table 1 Evolution of the antiretroviral treatment guidelines: when to start first-line treatment

All adolescents and adults with WHO Stage IV HIV disease, irrespective of the CD4 cell count; WHO Stage III disease with consideration of using CD4 cell counts.

All adolescents and adults including pregnant women with HIV infection and CD4 counts of ≤350 cells/mm3, should start ART, regardless of the presence or absence of clinical symptoms. Those with severe or advanced clinical disease (WHO clinical stage 3 or 4) should start ART irrespective of their CD4 cell count. In developing these recommendations, the panel placed high value on avoiding death, disease progression and HIV transmission over and above cost and feasibility.

All adolescents and adults with HIV diagnosis with a CD4 count of 500 cells/mm3 or less, giving priority to initiating ART among those with severe/advanced HIV disease or a CD4 count of 350 cells/mm3 or less. It is also recommended to initiate ART in people with active TB disease and HBV coinfection with severe chronic liver disease, all pregnant and breastfeeding women with HIV, all children younger than five years living with HIV and all individuals with HIV in sero-discordant relationships, regardless of CD4 cell count.

All adults living with HIV, regardless of WHO clinical stage and at any CD4 cell count. Priority will be given to all adults with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and adults with CD4 count ≤350 cells/mm3.