4.2 What to expect in the first months of ART

Although ART is a lifelong commitment, the first months of therapy are especially important. Clinical and immunological improvement and viral suppression are expected when individuals adhere to ART, but opportunistic infections (OIs) and/or immune reconstitution inflammatory syndrome (IRIS) may develop, as well as early adverse drug reactions, such as drug hypersensitivity, especially in the first three months of treatment. ART significantly decreases mortality overall, but death rates are also highest in the first three months of ART. These complications are most common when the people starting ART already have advanced HIV disease with severe immunodeficiency and existing coinfections and/or comorbidities, severely low haemoglobin, low body mass index and very low CD4 cell counts or are severely malnourished (6,7). Poor adherence in this period is also associated with the risk of early treatment failure and rapid development of drug resistance.

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