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Early antiretroviral therapy: The pendulum shifts again

Since the advent of highly active antiretroviral (HAART) in the mid-90s, the unequivocal benefit demonstrated by it in AIDS patients raised the question of the best time to initiate therapy. [1] Gradually, over the years, in response to increasing data, treatment schedules have changed from nucleoside reverse transcriptase inhibitors (NRTI) monotherapy to dual NRTI-based antiretroviral (ART) therapy and, most recently, to HAART. [2],[3] The euphoria over the efficacy of treatment initially led to a 'hit early-hit hard' [4] approach, which favored initiation of ART when the CD4 count decreased to less than 500 cells/cu mm or the plasma HIV RNA level rose to above 30,000 copies/ml. [5] This ...

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