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Changes in antiretroviral therapy guidelines: implications for public health policy and public purses
Alex Hamilton1, Jesus M Garcia-Calleja, Marco Vitoria
1St Vincent’s Hospital, NSW, Australia.
Insights
New antiretroviral therapy (ART) guidelines recommending earlier treatment initiation for HIV/AIDS increase the number of adults needing treatment. Earlier ART initiation significantly boosts demand for HIV services globally.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- The World Health Organization (WHO) revised antiretroviral therapy (ART) guidelines, recommending treatment for individuals with CD4 counts ≤350/mm³.
- Recommendations now include all people with HIV and active tuberculosis (TB) or chronic active hepatitis B, and all HIV-positive pregnant women, irrespective of CD4 count.
Purpose of the Study:
- To estimate the impact of revised WHO ART guidelines on treatment needs.
- To project the increased demand for ART across four diverse countries: Zambia, Kenya, Cameroon, and Vietnam.
Main Methods:
- Utilized WHO/UNAIDS country projections based on 2007 estimates.
- Employed Spectrum software to create new projections with modified CD4 progression rates for ART initiation.
- Compared new projections against baseline scenarios to quantify the impact of guideline changes.
Main Results:
- Initiating ART at CD4 <350/mm³ increases treatment demand by a median of 60% immediately and 42% by 2012.
- Increasing the ART initiation threshold to CD4 <500/mm³ doubles the immediate need for treatment and increases it by 84% by 2012.
- The pattern of increased treatment demand is consistent across the four studied countries.
Conclusions:
- Earlier initiation of ART, as per revised WHO guidelines, significantly increases the number of adults requiring treatment.
- These findings highlight the substantial impact on healthcare systems and the need for resource planning to meet increased ART demand.
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/mm(3), 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/mm(3) will increase the need for treatment by a median of 22% immediately, initiating ART at a CD4 count <350/mm(3) 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/mm(3). Initiating ART at a CD4 cell count <250/mm(3) would increase the need for treatment by a median of around 15% in 2012; initiating treatment at a CD4 count <350/mm(3) increases the need for treatment by a median of 42% across the same projections and about 84% if CD4 <500/mm(3) 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.
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