Abstract
ObjectiveTo report the viral load and CD4 count in HIV-infected, antiretroviral naïve, first -time HIV-testers, not immediately eligible for treatment initiation by current South Africa treatment guidelines.DesignThis was a cross-sectional study in a high-volume, free-of-charge HIV testing centre in Soweto, South Africa.MethodsWe enrolled first time HIV testers and collected demographic and risk-behaviour data and measured CD4 count and viral load.ResultsBetween March and October 2011, a total of 4793 adults attended VCT and 1062 (22%) tested positive. Of the 1062, 799 (75%) were ART naïve and 348/799 (44%) were first-time HIV testers. Of this group of 348, 225 (65%) were female. Overall their median age, CD4 count and viral load was 34 years (IQR: 28-41), 364 (IQR: 238-542) cells/mm3 and 13,000 (IQR: 2050-98171) copies/ml, respectively. Female first time HIV testers had higher CD4 counts (419 IQR: 262-582 vs. 303 IQR: 199-418 cells/mm3) and lower viral loads (9,100 vs. 34,000 copies/ml) compared to males. Of 183 participants with CD4 count >350 cells/mm3, 62 (34%) had viral loads > 10,000 copies/ml.ConclusionsA large proportion of HIV infected adults not qualifying for immediate ART at the CD4 count threshold of 350 cells/mm3 have high viral loads. HIV-infected men at their first HIV diagnosis are more likely to have lower CD4 counts and higher viral loads than women.
Highlights
Anti-retroviral therapy (ART) initiation has been shown to dramatically reduce HIV transmission in discordant heterosexual couples prompting revisions to treatment eligibility criteria. [1,2,3] Responding to this, new guidelines recommend starting ART either at HIV diagnosis, or at CD4 counts of #500 cells/mm3. [4,5] Current South African (SA) treatment guidelines for ART include recommendations for treatment initiation at a CD4 threshold of # 350 cells/mm3 in non-pregnant, well adolescents and adults.[4,5].ART initiation is traditionally based on CD4 counts
A large proportion of HIV infected adults not qualifying for immediate ART at the CD4 count threshold of 350 cells/mm3 have high viral loads
This study reports the distribution of CD4 counts and viral loads in ART-naıve, first-time HIV testers and relates CD4 counts to current South African ART initiation thresholds, and the proportion of participants not qualifying for immediate initiation of ART by the CD4 criterion but who have high viral loads and high potential of onward HIV transmission
Summary
Anti-retroviral therapy (ART) initiation has been shown to dramatically reduce HIV transmission in discordant heterosexual couples prompting revisions to treatment eligibility criteria. [1,2,3] Responding to this, new guidelines recommend starting ART either at HIV diagnosis, or at CD4 counts of #500 cells/mm3. [4,5] Current South African (SA) treatment guidelines for ART include recommendations for treatment initiation at a CD4 threshold of # 350 cells/mm in non-pregnant, well adolescents and adults.[4,5].ART initiation is traditionally based on CD4 counts. [1,2,3] Responding to this, new guidelines recommend starting ART either at HIV diagnosis, or at CD4 counts of #500 cells/mm. [4,5] Current South African (SA) treatment guidelines for ART include recommendations for treatment initiation at a CD4 threshold of # 350 cells/mm in non-pregnant, well adolescents and adults.[4,5]. This study reports the distribution of CD4 counts and viral loads in ART-naıve, first-time HIV testers and relates CD4 counts to current South African ART initiation thresholds, and the proportion of participants not qualifying for immediate initiation of ART by the CD4 criterion but who have high viral loads and high potential of onward HIV transmission
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