HIV management should begin ART when?

• A. Only after opportunistic infections develop
• B. As soon as possible after diagnosis, regardless of CD4 count
• C. After a year
• D. If CD4 count is above 500 only

Answer: (B)

Starting antiretroviral therapy as soon as HIV is diagnosed, regardless of CD4 count, is best because suppressing the virus early protects the immune system, lowers long-term HIV-related illness and death, and reduces the chance of transmission to others. Initiating treatment promptly leads to viral suppression, helps preserve CD4 cells, and decreases the risk of opportunistic infections and non-AIDS complications. It also aligns with the treat-all approach, which aims to reduce community viral load and transmission by treating everyone diagnosed with HIV. Delaying treatment until CD4 falls or until opportunistic infections occur misses these benefits, and waiting for a higher CD4 threshold is not recommended.