Abstract
Antiretroviral (ARV) therapy has greatly reduced HIV-related mortality, but treated patients still display excess mortality compared to HIV-negative individuals. This mortality is mostly driven by "non-AIDS defining conditions" such as cardiovascular and hepatic disease as well as non-AIDS related malignancies. One theory about the etiology of this excess mortality is that some patients with HIV may have systemic inflammation and/or states of hypercoagulability which persist during effective ARV therapy; these states may be central to the pathogenesis of the excess mortality seen in treated HIV patients. These theories have led many to revisit the question of the optimal timing of ARV initiation ("when to start"). While most now recommend ARV initiation when a patient's CD4+ count is