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Changes in antiretroviral therapy guidelines: implications for public health policy and public purses
  1. Alex Hamilton1,
  2. Jesus M Garcia-Calleja2,
  3. Marco Vitoria2,
  4. Charles Gilks2,
  5. Yves Souteyrand2,
  6. Kevin De Cock2,
  7. Siobhan Crowley2
  1. 1St Vincent's Hospital, NSW, Australia
  2. 2World Health Organization, Geneva, Switzerland
  1. Correspondence to Jesus M García Calleja, World Health Organization, 20 Avenue Appia, Geneva 27, Switzerland; callejaj{at}


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/mm3, 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/mm3 will increase the need for treatment by a median of 22% immediately, initiating ART at a CD4 count <350/mm3 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/mm3. Initiating ART at a CD4 cell count <250/mm3 would increase the need for treatment by a median of around 15% in 2012; initiating treatment at a CD4 count <350/mm3 increases the need for treatment by a median of 42% across the same projections and about 84% if CD4 <500/mm3 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.

  • ART needs
  • impact
  • policy
  • estimations
  • antiretroviral thera
  • epidemiology
  • HIV
  • prevalence

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  • Competing interests None.

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