Changing antiretroviral eligibility criteria: impact on the number and proportion of adults requiring treatment in Swaziland

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Bock, Naomi N ; Emerson, Ruth C ; Reed, Jason B ; Nkambule, Rejoice ; Donnell, Deborah J ; Bicego, George T ; Okello, Velephi ; Philip, Neena M ; Ehrenkranz, Peter D ; Duong, Yen T ; Moore, Janet S ; Justman, Jessica E
  More +
• Description:
  Objective ; Early initiation of antiretroviral treatment (ART) at CD4+ cell count ≥ 500 cells/μL reduces morbidity and mortality in HIV-infected adults. We determined the proportion of HIV-infected people with high viral load (VL) for whom transmission prevention would be an additional benefit of early treatment. ; Design ; A randomly selected sub-set of a nationally representative sample of HIV-infected adults in Swaziland in 2012. ; Methods ; Eight to twelve months after a national survey to determine adult HIV prevalence, 1,067 of 5,802 individuals identified as HIV-infected were asked to participate in a follow-up cross-sectional assessment. CD4+ cell enumeration, VL measurements and ART status were obtained to estimate the proportion of currently untreated adults and of the entire HIV-infected population with high VL (≥1000 copies/mL) whose treatment under a test-and-treat or VL threshold eligibility strategy would reduce HIV transmission. . ; Results ; Of the 927 (87% of 1,067) participants enrolled, 466 (50%) reported no ART use. Among them, 424 (91%) had VL ≥1000 copies/mL; of these, 148 (35%) were eligible for ART at the then existing CD4+ count threshold of <350 cells/μL; an additional 107 (25%) were eligible with expanded CD4+ criterion of <500 cells/μ; and 169 (40%) remained ART-ineligible. Thus 36% of the 466 currently untreated and 18% of the total 927 had high VL yet remained ART-ineligible under a CD4+ criterion of <500 cells/μL. ; Conclusions ; A test-and-treat or VL threshold for treatment eligibility is necessary to maximize the HIV transmission prevention benefits of ART.
• Subjects:
  • Adolescent
  • Adult
  • Anti-HIV Agents
  • CD4 Lymphocyte Count
  • Cross-Sectional Studies
  • Eswatini
  • Female
  • HIV Infections
  • Humans
  • Incidence
  More +
• Keywords:
  • HIV
  • antiretroviral therapy
  • HIV treatment eligibility
  • CD4+ count
  • viral load
  • Swaziland
• Source:
  J Acquir Immune Defic Syndr. 71(3):338-344
• Pubmed ID:
  26361174
• Pubmed Central ID:
  PMC4752404
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/ ; U2G PS002005/PS/NCHHSTP CDC HHSUnited States/ ; #5U2GPS002005/PHS HHSUnited States/
• Volume:
  71
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/38045/cdc_38045_DS1.pdf
• File Type:
  [PDF - 577.67 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1cfeba4c1e01c649a350ef8c0caed28c9a909cc34012e650d5e64114909fcd77