When should ART be initiated in HIV?

• A. As soon as possible after diagnosis
• B. After CD4 count falls below 200
• C. After completing OI prophylaxis
• D. Only if no opportunistic infections occur

Answer: (A)

Initiating antiretroviral therapy as soon as HIV is diagnosed is beneficial because suppressing the virus early preserves immune function, lowers the risk of AIDS-related illnesses, improves survival, and reduces HIV transmission to others (the person becomes less contagious once viral load falls to undetectable levels). Large studies showed that starting ART promptly, regardless of CD4 count, leads to better outcomes than waiting for the CD4 count to decline. ART should be started soon after diagnosis even if opportunistic infection prophylaxis is being initiated, though in certain specific opportunistic infections (like cryptococcal meningitis or active TB) the exact timing can be adjusted to minimize adverse inflammatory responses; the general rule remains early treatment.