When and how should antiretroviral therapy be initiated?

ART is recommended for all persons with HIV regardless of CD4 count. Rapid or same-day ART initiation is preferred for most patients to improve linkage to care and outcomes. Preferred initial regimens include integrase inhibitor-based combinations (bictegravir/TAF/FTC or dolutegravir-based). Resistance testing should be obtained but need not delay treatment. Exceptions for delayed start include cryptococcal meningitis and TB meningitis.