Antiretroviral therapy recommendations for the global community: Aspiration versus reality

摘要

Around 10 million people with HIV are on antiretroviral therapy (ART) and some countries in sub-Saharan Africa are now estimated to be treating 80% of those with CD4~+ cell count below 350per mul [1,2], representing substantial progress since the beginning of the global ART scale-up. The 2013 WHO treatment guidelines continue to map out a bold strategy [3], recommending a number of measures, including expanding the scope of HIV testing, phasing out use of the drug stavudine, introducing viral load monitoring, making plans for a third-line regimen, and expanding the number of people in whom treatment is recommended, including for all pregnant HIV-infected women and most notably to include adults with CD4~+ cell count in the 350-500 per mul range. The latter recommendations were in part influenced by the data in support of the efficacy of ART for prevention [4].