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Earlier initiation of antiretroviral therapy should be highest priority for expansion of HIV care, study finds

Date:
December 21, 2010
Source:
Public Library of Science
Summary:
Earlier initiation of antiretroviral therapy should be the highest priority for global expansion of HIV patient care. This finding, from a new study, should help resource-limited nations to phase in the implementation of the new 2010 WHO recommendations for HIV treatment.
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Earlier initiation of antiretroviral therapy should be the highest priority for global expansion of HIV patient care. This finding, from a paper published in PLoS Medicine, should help resource-limited nations to phase in the implementation of the new 2010 WHO recommendations for HIV treatment.

"Immediate scale-up of the entire WHO guideline package may be prohibitively expensive in some settings," said lead author Rochelle P. Walensky, MD, MPH of the Massachusetts General Hospital, Boston. "In many resource-limited settings, the relevant policy question is: What to do first?"

The new WHO guidelines include three major changes: initiation of ART when CD4 levels drop below 350/µl, rather than waiting until they reach 200/µl; replacing the antiretroviral drug stavudine with the less-toxic but more expensive tenofovir for first-line treatment, and switching patients to second-line ART regimens when the first-line regimen fails.

Findings from Walensky and colleagues demonstrate that earlier ART initiation increased 5-year survival from 80 to 87% and showed substantially improved early clinical outcomes compared to either using tenofovir for first-line treatment or providing second-line regimens. In settings where ART initiation at 350/μl is already available, switching stavudine to tenofovir offers clinical benefit and is less costly than adding second-line regimens. Finally, the authors demonstrate that the availability of second-line regimens offers major survival benefits (greater than 4 years per person) but at substantial increases in cost.

The authors conclude: "The entire package of recommendations proposed by the WHO is cost-effective in South Africa (incremental cost-effectiveness ratio of US$2,370 per year of life saved). However, in settings where immediate implementation of all of the new WHO treatment guidelines is not currently feasible, antiretroviral treatment initiation at CD4 < 350/µl provides the greatest short- and long-term survival advantage and is highly cost-effective."

Rochelle Walensky is an Associate Professor of Medicine at Harvard Medical School. Additional co-authors of the PLoS Medicine report are Andrea L. Ciaranello MD, MPH, Sarah B. Lorenzana, Adam W. Stoler and Kenneth A. Freedberg, MD, MSc, MGH Department of Medicine; Robin Wood, FCP, MMed, DTM&H, Desmond Tutu HIV Centre, University of Cape Town; A. David Paltiel, PhD, Yale School of Medicine; and Xavier Anglaret, MD, PhD, INSERM Unité 897, Centre de Recherche "Epidémiologie et Biostatistique." The study was supported by grants from the NIAID, NIDA, and the Doris Duke Charitable Foundation.


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Journal Reference:

  1. Rochelle P. Walensky, Robin Wood, Andrea L. Ciaranello, A. David Paltiel, Sarah B. Lorenzana, Xavier Anglaret, Adam W. Stoler, Kenneth A. Freedberg, for the CEPAC-International Investigators. Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis. PLoS Medicine, 2010; 7 (12): e1000382 DOI: 10.1371/journal.pmed.1000382

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Public Library of Science. "Earlier initiation of antiretroviral therapy should be highest priority for expansion of HIV care, study finds." ScienceDaily. ScienceDaily, 21 December 2010. <www.sciencedaily.com/releases/2010/12/101221172252.htm>.
Public Library of Science. (2010, December 21). Earlier initiation of antiretroviral therapy should be highest priority for expansion of HIV care, study finds. ScienceDaily. Retrieved June 14, 2024 from www.sciencedaily.com/releases/2010/12/101221172252.htm
Public Library of Science. "Earlier initiation of antiretroviral therapy should be highest priority for expansion of HIV care, study finds." ScienceDaily. www.sciencedaily.com/releases/2010/12/101221172252.htm (accessed June 14, 2024).

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