Based on evidence from clinical trials, the U.S. Department of Health and Human Services (DHHS) and the European Guidelines agree that all HIV-positive adults with a CD4 count below 200 cells/mm³ should be started on ART. Thus, when a CD4 count is in fact available, 200 cells/mm³ should be the minimum standard for initiating ART.

Other studies suggest that patients with a CD4 count below 350 cells/mm³ also benefit from ART. In Haiti and Rwanda, as in many HIV-endemic countries, more aggressive pathogens such as TB and salmonella are associated with high morbidity and mortality among HIV-positive patients. Therefore, in PIH projects, the decision to initiate ART is based on this more conservative guideline of 350 cells/mm³. See Section 2.4.3 for a discussion of ART initiation in co-infected patients.

Lastly, a small subset of persons with a CD4 count above 350 cells/mm³ may merit ART based on symptoms that indicate either that the patient is failing to thrive or that the patient is suffering from recurrent OIs.

* All protocols for Chapter 3 are grouped at the end of the chapter, immediately before the References.