There are many different guidelines published by different medical/scientific bodies concerning how HIV therapy should be managed in countries with adequate resources.   The common themes are:

• HIV treatment should be started once a patient’s CD4 count is depleted below a certain level and or the virus is above a certain level, or they show symptoms of HIV disease.
• A resistance test may be used to help decide which drugs to start as the patient may have been infected with virus that is already resistant to some drugs.  The most common form of resistance test is a genotype, which detects the points in the virus’s genetic code where it has mutated. This information is then interpreted in terms of whether the mutations may make the virus resistant to certain drugs
• Once the patient is being treated the success of the treatment is monitored by regularly measuring the amount of virus in the blood and the level of CD4 cells. If these indicate the drugs are not working well, or if the patient is not tolerating the therapy well, then the physician will need to change the drugs.
• At this point another genotype may be performed to determine which drugs the virus may be resistant to and a new combination of drugs selected and introduced.
• This process is repeated each time that treatment fails.