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14th Annual Conference of the British HIV Association23–25 April 2008, Belfast |
WHAT ARE THE IMPLICATIONS OF INCREASING THE RECOMMENDED THRESHOLD FOR STARTING ANTI-HIV THERAPY (ART)?
HIV Med 2008; 9(Suppl. 1):6 (abstract no. O20)
T Chadborn and V Delpech
Health Protection Agency, London, UK
BACKGROUND/AIM: United States and European guidelines now recommend that HIV-infected persons start ART before CD4 falls below 350 cells/mm3. Our aim was to consider some of the implications of a similar recommendation being implemented in the UK.
METHODS: Analysis of reports to HIV surveillance systems: SOPHID (cross-sectional survey of persons accessing HIV care), CD4 Surveillance, and reports of new HIV diagnoses. Analysis of persons with CD4, VL and ARV status reported, which was 80% (38,968/48,663) of all adults (>15 yrs) seen for HIV-related care in England, Wales and Northern Ireland in 2006.
RESULTS: Effect on late diagnosis: An estimated 33% of adults were diagnosed with CD4 <200 and 57% with CD4 <350 in 2006. Additional requirement for treatment: 27,391 (70%) of adults were on ART. 3,060 (8%) adults had 199 <CD4 <350 and were not on ART and 727 (2%) had CD4 <200 and were not on ART. 1760 (58%) and 216 (30%) of these adults respectively were diagnosed for >3 months and had never been on ART. Possible effect on transmission: 77% (9,529) of adults had a VL >499 and were not on ART. Of these, 28% (2,686) had 199 <CD4 <350 and 6% (608) had CD4 <200.
CONCLUSIONS/DISCUSSION: There are likely to be both clinical and public health benefits of recommending all HIV-infected persons to start ART if CD4 <350 but some of the implications are:
2008-04-23
O20
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