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In most countries CD4+ cell counts are still used for deciding when to startHIV-positive people on anti-retroviral therapy. However, various CD4+thresholds, 200, 350 or 500/\muL, are chosen arbitrarily and for historicalreasons. Here we consider the optimal CD4+ threshold at which asymptomaticHIV-positive people living in Botswana, South Africa and Zimbabwe should starttreatment depending on their prognosis given their CD4+ cell counts or viralload. We also examine the optimal interval at which people should be retestedif they are HIV-negative. This analysis shows that while the use of CD4+ cellcounts or viral load tests could have been useful in deciding how to triagepatients for treatment at the start of the epidemic this is no longer the caseexcept possibly for those aged about 15 to 25 years. In order not to do harm toindividual patients everyone should be started on ART as soon as they are foundto be HIV-positive.

Anti-retroviral therapy for HIV: who should we test and who should we treat?