Cost-effectiveness implications of the timing of antiretroviral therapy in HIV-infected adults.

Abstract
BY 1997, the dramatic success of highly active antiretroviral therapy in reducing acquired immunodeficiency syndrome (AIDS)–related mortality led to clinical guidelines that recommended early initiation of treatment for human immunodeficiency virus (HIV)–infected individuals with asymptomatic disease, regardless of CD4 cell count.1,2 Since then, however, adverse effects associated with longer-term antiretroviral therapy have been identified, including cholesterol changes, fat redistribution symptoms, impaired glucose tolerance, and osteopenia.3-9 Concerns about these long-term adverse effects have contributed to a reevaluation of recommendations about when to initiate treatment.10-12