Is the need for ART being grossly underestimated?

摘要

Matthias Egger and colleagues (March 11, p 817) showthat mortality rates in the first year of antiretroviral therapy (ART) are higher in developing countries than developed ones. As do many others, they quote WHO estimates that 6-5 million people are in urgent need of ART. In fact, application of WHO guidelines for starting ART, suggests that this figure is a substantial underestimate.The guidelines recommend treatment for individuals with clinical AIDS (WHO stage 4), for those at stage 3 and who have CD4-cell counts of less than 350 per ul, and for others with CD4-cell 'counts of less than 200 per ui. Data on the numbers in each of these categories are not available,but each year 5 million enter the HIV-positive population of 40 million, and 3 million leave it. If average survival is 10 years, the distribution byyearwill be about that shown in the figure. Almost all of this population is treatment naive. Only around 1-3 million are on ART in developing countries.So the rate of decline in CD4-cell counts and progression to AIDS and death in this population should be close to those in the pre-ART era.