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Antiretroviral therapy needs: the effect of changing global guidelines
  1. Karen Stanecki1,
  2. Juliana Daher1,
  3. John Stover2,
  4. Michel Beusenberg3,
  5. Yves Souteyrand3,
  6. Jesus M Garcia Calleja3
  1. 1UNAIDS, Geneva, Switzerland
  2. 2The Futures Institute, Glastonbury, Connecticut, USA
  3. 3World Health Organization, Geneva, Switzerland
  1. Correspondence to Karen Stanecki, UNAIDS, 20 Avenue Appia, 1211 Geneva, 27, Switzerland; staneckik{at}unaids.org

Abstract

Background In 2010 the WHO issued a revision of the guidelines on antiretroviral therapy (ART) for HIV infection in adults and adolescents. The recommendations included earlier diagnosis and treatment of HIV in the interest of a longer and healthier life. The current analysis explores the impact on the estimates of treatment needs of the new criteria for initiating ART compared with the previous guidelines.

Methods The analyses are based on the national models of HIV estimates for the years 1990–2009. These models produce time series estimates of ART treatment need and HIV-related mortality. The ART need estimates based on ART eligibility criteria promoted by the 2010 WHO guidelines were compared with the need estimates based on the 2006 WHO guidelines.

Results With the 2010 eligibility criteria, the proportion of people living with HIV currently in need of ART is estimated to increase from 34% to 49%. Globally, the need increases from 11.4 million (10.2–12.5 million) to 16.2 million (14.8–17.1 million). Regional differences include 7.4 million (6.4–8.4 million) to 10.6 million (9.7–11.5 million) in sub-Saharan Africa, 1.6 million (1.3–1.7 million) to 2.4 million (2.1–2.5 million) in Asia and 710 000 (610 000–780 000) to 950 000 (810 000–1.0 million) in Latin America and the Caribbean.

Conclusions When adopting the new recommendations, countries have to adapt their planning process in order to accelerate access to life saving drugs to those in need. These recommendations have a significant impact on resource needs. In addition to improving and prolonging the lives of the infected individuals, it will have the expected benefit of reducing HIV transmission and the future HIV/AIDS burden.

  • Models
  • HIV
  • antiretroviral therapy

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/sti.2010.046177

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    Footnotes

    • Funding KS developed and drafted the paper; JD provided analytical and data management support; JS drafted sections, provided comments and developed the Spectrum software package; MB provided data support; YS and JMGC provided comments.

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.