New evidence has emerged regarding when to commence antiretroviral therapy (ART), optimal treatment\nregimens, management of HIV co-infection with opportunistic infections, and management of ART failure. The 2014\nguidelines were developed by the collaborations of the Department of Disease Control, Ministry of Public Health\n(MOPH) and the Thai AIDS Society (TAS). One of the major changes in the guidelines included recommending to\ninitiating ART irrespective of CD4 cell count. However, it is with an emphasis that commencing HAART at CD4 cell\ncount above 500 cell/mm3 is for public health, in term of preventing HIV transmission and personal benefit. In\ntuberculosis co-infected patients with CD4 cell counts ?50 cells/mm3 or with CD4 cell counts >50 cells/mm3 who\nhave severe clinical disease, ART should be initiated within 2 weeks of starting tuberculosis treatment. The\npreferred initial ART regimen in treatment na�¯ve patients is efavirenz combined with tenofovir and emtricitabine\nor lamivudine. Plasma HIV viral load assessment should be done twice a year until achieving undetectable results;\nand will then be monitored once a year. CD4 cell count should be monitored every 6 months until CD4 cell\ncount ?350 cells/mm3 and with plasma HIV viral load <50 copies/mL; then it should be monitored once a year\nafterward. HIV drug resistance genotypic test is indicated when plasma HIV viral load >1,000 copies/mL while on\nART. Ritonavir-boosted lopinavir or atazanavir in combination with optimized two nucleoside-analogue reverse\ntranscriptase inhibitors is recommended after initial ART regimen failure. Long-term ART-related safety monitoring\nhas also been included in the guidelines.
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