Starting Antiviral Therapy With the greater use of viral load testing, medical providers have new data with which to determine when to start an individual on antiviral therapy. Only a year ago, most physicians would have agreed that a viral load of less than 10,000 was probably acceptable. Today, that thinking has changed. If the goal is to reduce the viral load as low as possible for as long as possible, then anyone with a detectable viral load should be considered a candidate for antiviral therapy. This is a big change in treatment approach over just the last year.
Most physicians recommend two reverse transcriptase inhibitors.
Some would add a protease inhibitor as well, especially if the individual has a long standing infection with viral load above a certain threshold or CD4 below a certain threshold. Defining that threshold, however, varies from physician to physician. For the last couple of years, AZT plus 3TC has been the most common initial combination antiviral regimen. Previous thinking was that AZT had the advantage here. Some experts are questioning whether 3TC is the best drug to start with.