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December 31, 2013

Slow Progress in Getting Africans on ARVs Early in HIV Disease

The proportion of sub-Saharan Africans beginning antiretroviral (ARV) treatment with advanced HIV disease is falling, but their median CD4 count upon entry is increasing far too slowly, aidsmap reports. Advanced HIV disease is defined by a CD4 count below 100 or a diagnosis of conditions categorized by the World Health Organization as stage 4 HIV disease, including pneumocystis pneumonia (PCP), Kaposi’s sarcoma (KS) and cytomegalovirus (CMV), among many others.

Publishing their findings in Clinical Infectious Diseases, investigators analyzed data about 335,000 adults receiving HIV care in sub-Saharan Africa, including 149,000 who began HIV treatment between 2006 and 2011 at 132 health facilities in Kenya, Mozambique, Rwanda and Tanzania.

In 2006, the median CD4 count upon beginning ARVs was 125, a figure that crept up to 185 by 2011. This is progress the study authors described as “discouragingly slow,” noting that at this rate 15 years would have to pass before the CD4 count median hit a more immunologically stable 350.

During the same time period, the proportion of those starting HIV treatment with advanced HIV disease dropped from 42 percent to 29 percent. However, there were disparities: In 2011, men were 60 percent more likely than women to start ARVs with advanced HIV disease, and those with tuberculosis were 60 percent more likely to do so than those without. Those who hadn’t been in care for more than a year before starting treatment were twice as likely to have advanced HIV disease at the time than those who had been retained in pre-ARV care within a year.

The study’s authors urged greater efforts to identify people needing treatment earlier in the course of their HIV disease and to strive to better retain them in care.

To read the aidsmap story, click here.

To read the study abstract, click here.

Search: Early HIV disease, antiretrovirals, sub-Saharan Africans, advanced HIV disease, World Health Organization, Clinical Infectious Diseases.

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