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Changing antiretroviral eligibility criteria: impact on the number and proportion of adults requiring treatment in Swaziland
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3 1 2016
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Source: J Acquir Immune Defic Syndr. 71(3):338-344
[PDF-577.67 KB]
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Alternative Title:J Acquir Immune Defic Syndr
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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.
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Pubmed ID:26361174
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Pubmed Central ID:PMC4752404
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Volume:71
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Issue:3
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