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

Hamilton, Alex, Garcia-Calleja, Jesus M., Vitoria, Marco, Gilks, Charles, Souteyrand, Yves, De Cock, Kevin and Crowley, Siobhan (2010) Changes in antiretroviral therapy guidelines: implications for public health policy and public purses. Sexually Transmitted Infections, 86 5: 388-390. doi:10.1136/sti.2010.043018


Author Hamilton, Alex
Garcia-Calleja, Jesus M.
Vitoria, Marco
Gilks, Charles
Souteyrand, Yves
De Cock, Kevin
Crowley, Siobhan
Title Changes in antiretroviral therapy guidelines: implications for public health policy and public purses
Journal name Sexually Transmitted Infections   Check publisher's open access policy
ISSN 1368-4973
Publication date 2010-10
Year available 2010
Sub-type Article (original research)
DOI 10.1136/sti.2010.043018
Open Access Status
Volume 86
Issue 5
Start page 388
End page 390
Total pages 3
Place of publication London, United Kingdom
Publisher B M J Group
Collection year 2010
Language eng
Formatted abstract
Introduction The 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.

Methods The 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.

Results The 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.

Conclusions The 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. 
Keyword Middle Income Countries
Collaborative Analysis
Hiv 1 Infected Patients
Hiv
Initiation
Prognosis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
 
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