Earlier initiation of antiretroviral therapy should be highest priority for expansion of HIV care

Dec 21, 2010

Earlier initiation of antiretroviral therapy should be the highest priority for global expansion of HIV patient care. This finding, from a paper published in this week's PLoS Medicine, should help resource-limited nations to phase in the implementation of the new 2010 WHO recommendations for HIV treatment.

"Immediate scale-up of the entire WHO guideline package may be prohibitively expensive in some settings," said lead author Rochelle P. Walensky, MD, MPH of the Massachusetts General Hospital, Boston, USA. "In many resource-limited settings, the relevant policy question is: What to do first?"

The new WHO guidelines include three major changes: initiation of ART when CD4 levels drop below 350/µl, rather than waiting until they reach 200/µl; replacing the antiretroviral drug stavudine with the less-toxic but more expensive tenofovir for first-line treatment, and switching patients to second-line ART regimens when the first-line regimen fails.

Findings from Walensky and colleagues demonstrate that earlier ART initiation increased 5-year survival from 80 to 87% and showed substantially improved early clinical outcomes compared to either using tenofovir for first-line treatment or providing second-line regimens. In settings where ART initiation at 350/μl is already available, switching stavudine to tenofovir offers clinical benefit and is less costly than adding second-line regimens. Finally, the authors demonstrate that the availability of second-line regimens offers major survival benefits (greater than 4 years per person) but at substantial increases in cost.

The authors conclude: "The entire package of recommendations proposed by the WHO is cost-effective in South Africa (incremental cost-effectiveness ratio of US$2,370 per year of life saved). However, in settings where immediate implementation of all of the new WHO treatment guidelines is not currently feasible, antiretroviral treatment initiation at CD4 < 350/µl provides the greatest short- and long-term survival advantage and is highly cost-effective."

Explore further: Point-of-care CD4 testing is economically feasible for HIV care in resource-limited areas

More information: Walensky RP, Wood R, Ciaranello AL, Paltiel AD, Lorenzana SB, et al. (2010) Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis. PLoS Med 7(12): e1000382. doi:10.1371/journal.pmed.1000382

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

The genetics of coping with HIV

19 hours ago

We respond to infections in two fundamental ways. One, which has been the subject of intensive research over the years, is "resistance," where the body attacks the invading pathogen and reduces its numbers. Another, which ...

Long acting HIV drugs to be developed

Sep 11, 2014

HIV drugs which only need to be taken once a month are to be developed at the University of Liverpool in a bid to overcome the problem of 'pill fatigue'.

Puerto Rico partners on US HIV vaccine project

Sep 10, 2014

Puerto Rico's governor says the island's largest public university is partnering with federal agencies to oversee a U.S.-funded project aimed at trying to develop a prophylactic vaccine for the HIV virus that causes AIDS.

User comments : 0