A decision tree to help determine the best timing and antiretroviral strategy in HIV-infected patients

Optimal antiretroviral strategies for HIV-infected patients still need to be established. To this end a decision tree including different antiretroviral strategies that could be adopted for HIV-infected patients was built. A 10-year follow-up was simulated by using transitional probabilities estimated from a large cohort using a time-homogeneous Markov model. The desired outcome was for patients to maintain a CD4 cell count of >500 cells/mm(3) without experiencing AIDS or death. For patients with a baseline HIV viral load >= 5 log(10) copies/ml, boosted protease inhibitor-based immediate highly active antiretroviral therapy (HAART) allowed them to spend 12% more time with CD4 >= 500/mm(3) than did delayed HAART (6.40 vs. 5.69 and 5.57 vs. 4.90 years for baseline CD4 >= 500 and 350-499/mm(3), respectively). In patients with a baseline HIV viral load <3.5 log10 copies/ml, delayed HAART performed better than immediate HAART (6.43 vs. 6.26 and 5.95 vs. 5.18 for baseline CD4 >= 500 and 350-499/mm(3), respectively). Immediate HAART is beneficial in patients with a baseline HIV viral loado >= 5 log(10) copies/ml, whereas deferred HAART appears to be the best option for patients with CD4 >= 350/mm(3) and baseline HIV viral load <3.5 log(10) copies/ml.