Challenges in initiating antiretroviral therapy for all HIV-infected people regardless of CD4 cell count  

作　　者：Jean Joel R.Bigna Claudia S.Plottel Sinata Koulla-Shiro 

机构地区：[1]Department of Epidemiology and Public Health,Centre Pasteur of Cameroon,451,Rue 2005,P.O.Box 1274,Yaounde,Cameroon [2]Bordeaux School of Public Health,University of Bordeaux,Bordeaux,France [3]Department of Medicine,Division of Translational Medicine,New York University Langone Medical Center,New York,NY,USA [4]Faculty of Medicine and Biomedical Sciences,University of Yaounde 1,Yaoundé,Cameroon [5]Infectious Diseases Unit,Yaounde Central Hospital,Yaounde,Cameroon

出　　处：《Infectious Diseases of Poverty》2016年第1期787-792,共6页贫困所致传染病（英文）

摘　　要：Introduction:Recently published large randomized controlled trials,START,TEMPRANO and HPTN 052 show the clinical benefit of early initiation of antiretroviral treatment(ART)in HIV-infected persons and in reducing HIV transmission.The trials influenced the World Health Organization(WHO)decision to issue updated recommendations to prescribe ART to all individuals living with HIV,irrespective of age and CD4 cell count.Discussion:It is clear that the new 2015 WHO recommendations if followed,will change the face of the HIV epidemic and probably curb its burden over time.Implementation however,requires that health systems,especially those in low and middle-income settings,be ready to face this challenge on a large scale.HIV prevention and treatment are easy in theory yet hard in practice.The new WHO guidelines for initiation of ART regardless of CD4 cell count will lead to upfront increases in the costs of healthcare delivery as the goal is to treat all those now newly eligible for ART.Around 22 million people living with HIV qualify and will therefore require ART.Related challenges immediately follow:firstly,that everyone must be tested for HIV;secondly,that anyone who has had an HIV test should know their result and understand its significance;and,thirdly,that every person identified as HIV-positive should receive and remain on ART.The emergence of HIV drug resistant strains when treatment is started at higher CD4 cell count thresholds is a further concern as persons on HIV treatment for longer periods of time are at increased risk of intermittent medication adherence.Conclusions:The new WHO recommendations for ART are welcome,but lacking as they fail to consider meaningful solutions to the challenges inherent to implementation.They fail to incorporate actual strategies on how to disseminate and adopt these far-reaching guidelines,especially in sub-Saharan Africa,an area with weak healthcare infrastructures.Well-designed,high-quality research is needed to assess the feasibility,safety,acceptability,impact,and cost of

关 键 词：CHALLENGES CD4 count Resource limited setting HIV WHO guidelines Early initiation Immediate initiation ANTIRETROVIRAL Universal access 

分 类 号：R51[医药卫生—内科学]