CD4 Cell Count: Declining Value for Antiretroviral Therapy Eligibility

Antiretroviral therapy (ART) policy for people living with human immunodeficiency virus (HIV) has historically been based on clinical indications, such as opportunistic infections and CD4 cell counts. Studies suggest that CD4 counts early in HIV infection do not predict relevant public health outcom...

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Vydáno v:Clinical infectious diseases Ročník 62; číslo 8; s. 1022
Hlavní autoři: Ying, Roger, Granich, Reuben M, Gupta, Somya, Williams, Brian G
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 15.04.2016
Témata:
Anti-HIV Agents - therapeutic use
Antiretroviral Therapy, Highly Active - standards
CD4 Lymphocyte Count
Continuity of Patient Care
Disease Progression
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV Infections - immunology
HIV Infections - prevention & control
Humans
CD4 cell count
ART
HIV
care continuum
universal test and treat
ISSN:1537-6591, 1537-6591
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Abstract Antiretroviral therapy (ART) policy for people living with human immunodeficiency virus (HIV) has historically been based on clinical indications, such as opportunistic infections and CD4 cell counts. Studies suggest that CD4 counts early in HIV infection do not predict relevant public health outcomes such as disease progression, mortality, and HIV transmission in people living with HIV. CD4 counts also vary widely within individuals and among populations, leading to imprecise measurements and arbitrary ART initiation. To capture the clinical and preventive benefits of treatment, the global HIV response now focuses on increasing HIV diagnosis and ART coverage. CD4 counts for ART initiation were necessary when medications were expensive and had severe side effects, and when the impact of early ART initiation was unclear. However, current evidence suggests that although CD4 counts may still play a role in guiding clinical care to start prophylaxis for opportunistic infections, CD4 counts should cease to be required for ART initiation.
AbstractList Antiretroviral therapy (ART) policy for people living with human immunodeficiency virus (HIV) has historically been based on clinical indications, such as opportunistic infections and CD4 cell counts. Studies suggest that CD4 counts early in HIV infection do not predict relevant public health outcomes such as disease progression, mortality, and HIV transmission in people living with HIV. CD4 counts also vary widely within individuals and among populations, leading to imprecise measurements and arbitrary ART initiation. To capture the clinical and preventive benefits of treatment, the global HIV response now focuses on increasing HIV diagnosis and ART coverage. CD4 counts for ART initiation were necessary when medications were expensive and had severe side effects, and when the impact of early ART initiation was unclear. However, current evidence suggests that although CD4 counts may still play a role in guiding clinical care to start prophylaxis for opportunistic infections, CD4 counts should cease to be required for ART initiation.
Antiretroviral therapy (ART) policy for people living with human immunodeficiency virus (HIV) has historically been based on clinical indications, such as opportunistic infections and CD4 cell counts. Studies suggest that CD4 counts early in HIV infection do not predict relevant public health outcomes such as disease progression, mortality, and HIV transmission in people living with HIV. CD4 counts also vary widely within individuals and among populations, leading to imprecise measurements and arbitrary ART initiation. To capture the clinical and preventive benefits of treatment, the global HIV response now focuses on increasing HIV diagnosis and ART coverage. CD4 counts for ART initiation were necessary when medications were expensive and had severe side effects, and when the impact of early ART initiation was unclear. However, current evidence suggests that although CD4 counts may still play a role in guiding clinical care to start prophylaxis for opportunistic infections, CD4 counts should cease to be required for ART initiation.Antiretroviral therapy (ART) policy for people living with human immunodeficiency virus (HIV) has historically been based on clinical indications, such as opportunistic infections and CD4 cell counts. Studies suggest that CD4 counts early in HIV infection do not predict relevant public health outcomes such as disease progression, mortality, and HIV transmission in people living with HIV. CD4 counts also vary widely within individuals and among populations, leading to imprecise measurements and arbitrary ART initiation. To capture the clinical and preventive benefits of treatment, the global HIV response now focuses on increasing HIV diagnosis and ART coverage. CD4 counts for ART initiation were necessary when medications were expensive and had severe side effects, and when the impact of early ART initiation was unclear. However, current evidence suggests that although CD4 counts may still play a role in guiding clinical care to start prophylaxis for opportunistic infections, CD4 counts should cease to be required for ART initiation.
Author Granich, Reuben M
Williams, Brian G
Gupta, Somya
Ying, Roger
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  surname: Ying
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  organization: Weill Cornell Medical College, Cornell University, New York, New York
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  givenname: Reuben M
  surname: Granich
  fullname: Granich, Reuben M
  organization: International Association of Providers of AIDS Care, Washington D.C
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  givenname: Somya
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  givenname: Brian G
  surname: Williams
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  organization: South African Department of Science and Technology/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa
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Copyright The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.
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Keywords CD4 cell count
ART
HIV
care continuum
universal test and treat
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References 27143658 - Clin Infect Dis. 2016 Jun 15;62(12):1621
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SubjectTerms Anti-HIV Agents - therapeutic use
Antiretroviral Therapy, Highly Active - standards
CD4 Lymphocyte Count
Continuity of Patient Care
Disease Progression
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV Infections - immunology
HIV Infections - prevention & control
Humans
Title CD4 Cell Count: Declining Value for Antiretroviral Therapy Eligibility
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