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: Animal study provides first evidence that gel can prevent multiple virus transmission in vagina/rectum

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

HIV+ women respond well to HPV vaccine

Apr 16, 2014

HIV-positive women respond well to a vaccine against the human papillomavirus (HPV), even when their immune system is struggling, according to newly published results of an international clinical trial. The study's findings ...

User comments : 0

More news stories

Treating depression in Parkinson's patients

A group of scientists from the University of Kentucky College of Medicine and the Sanders-Brown Center on Aging has found interesting new information in a study on depression and neuropsychological function in Parkinson's ...

Airbnb rental site raises $450 mn

Online lodging listings website Airbnb inked a $450 million funding deal with investors led by TPG, a source close to the matter said Friday.

Health care site flagged in Heartbleed review

People with accounts on the enrollment website for President Barack Obama's signature health care law are being told to change their passwords following an administration-wide review of the government's vulnerability to the ...