Changes in antiretroviral therapy guidelines: implications for public health policy and public purses

• Published in: Sexually transmitted infections Vol. 86; no. 5; pp. 388 - 390
• Main Authors: Hamilton, Alex, Garcia-Calleja, Jesus M, Vitoria, Marco, Gilks, Charles, Souteyrand, Yves, De Cock, Kevin, Crowley, Siobhan
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group 01.10.2010; BMJ Publishing Group LTD
• Subjects: Adult; Africa; Antiretroviral Therapy, Highly Active; Biological and medical sciences; CD4 Lymphocyte Count; Cost of Illness; Epidemiology. Vaccinations; Female; General aspects; Health Policy; HIV Infections - drug therapy; HIV Infections - economics; Human immunodeficiency virus; Human infectious diseases. Experimental studies and models; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Mycobacterium; Needs Assessment; Practice Guidelines as Topic; Time Factors; Vietnam; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Vietnam; Africa; Immunopathology; Antiretroviral agent; AIDS; Immune deficiency; Recommendation; Infection; Chemotherapy; Treatment; Sexually transmitted disease; Health policy; Viral disease; Antiviral; Public health
• ISSN: 1368-4973; 1472-3263; 1472-3263
• DOI: 10.1136/sti.2010.043018

IntroductionThe World Health Organization (WHO) published a revision of the antiretroviral therapy (ART) guidelines and now recommends ART for all those with a CD4 cell count ≤350/mm3, for people with HIV and active tuberculosis (TB) or chronic active hepatitis B irrespective of CD4 cell count and all HIV-positive pregnant women. A study was undertaken to estimate the impact of the new guidelines using four countries as examples.MethodsThe current WHO/UNAIDS country projections were accessed based on the 2007 estimates for Zambia, Kenya, Cameroon and Vietnam. New projections were created using Spectrum. CD4 progression rates to need for ART were modified and compared with the baseline projections.ResultsThe pattern of increased need for treatment is similar across the four projections. Initiating treatment at a CD4 count <250/mm3 will increase the need for treatment by a median of 22% immediately, initiating ART at a CD4 count <350/mm3 increases the need for treatment by a median of 60%, and the need for treatment doubles if ART is commenced at a CD4 count <500/mm3. Initiating ART at a CD4 cell count <250/mm3 would increase the need for treatment by a median of around 15% in 2012; initiating treatment at a CD4 count <350/mm3 increases the need for treatment by a median of 42% across the same projections and about 84% if CD4 <500/mm3 was used.ConclusionsThe projections indicate that initiating ART earlier in the course of the disease by increasing the threshold for the initiation of ART would increase the numbers of adults in need of treatment immediately and in the future.