Abstract
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Highlights
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South Africa bears 20% of the global HIV burden, with approximately 3 million people accessing ARVs and a similar number still in need of antiretroviral therapy (ART). With such large numbers of people accessing care through a public health programme, cost remains a critical factor that needs to be considered with regard to each and every aspect of the programme
Despite the fact that mortality was not reduced in HPTN 052, the major benefit demonstrated in the study was a 96% reduction in HIV infection amongst serodiscordant couples in which the HIVpositive partner was initiated at the higher CD4 count threshold, as opposed to delaying to CD4 < 250 cells/mm3.13 These data are a compelling argument for moving towards ‘Test and Treat’ (ART initiation independent of CD4 count), as recommended in the latest iteration of World Health Organization (WHO) guidelines (2015).[14]
Summary
Read online: Scan this QR code with your smart phone or mobile device to read online. The CD4 count is an important predictor of disease progression[1,2,3,4,5] and death,[6,7,8] and has informed us when to start antiretroviral therapy (ART), opportunistic infection (OI) risk stratification (especially in late presenting patients), when to start and stop OI prophylaxis or management, as well as in monitoring response to treatment.[8,9,10] in areas where viral loads are readily available and patients are virologically suppressed and stable, the question arises – is there a role for continued CD4 count monitoring in this setting?
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