WHO ART guidelines and beyond: Should CD4 count be a barrier to ART initiation

摘要

WHO 2013 guidelines suggest that the CD4 threshold for antiretroviral initiation be elevated from 350 to 500 cells/ul, in patients with HIV. This follows many (but not all) developed country guidelines, which have elevated the threshold or done away with it altogether, based on data suggesting clinical benefit, as well as modelling studies showing significant public health benefit in arresting new transmission. However, there has been criticism of the new recommendation on many fronts, ranging from questioning of the absolute clinical benefit to the individual starting early, the extent of the HIV prevention benefits of earlier initiation, to concerns regarding the cost and operational feasibility of expanding an already ambitious programme beyond current CD4 strata.