Study shows substantial increases in the number of
people requiring treatment
A study by the CASCADE Collaboration in EuroCoord has
estimated that there will be a substantial increase in the number
of HIV positive people who will require treatment within the first
5 years after becoming infected, following changes in treatment
guidelines.
HIV positive people start treatment when
important cells in their immune system, called CD4 cells, fall
below a certain threshold.
Updates to the International
AIDS Society-United States (IAS-US),
Department of Health and Human Services (DHHS), and
World
Health Organisation guidelines have raised the thresholds for
treatment initiation from 350 to 500 CD4 cells/mm3 in
the United States and from 200 to 350 CD4 cells/mm3 in
mid- and low-income countries. The threshold for treatment
initiation remains at 350 CD4 cells/mm3 in
Europe. 
To assess the likely impact of these changes
on the number of HIV positive people in need of treatment, the
authors used CASCADE data from
18,495 people with well-estimated dates of HIV infection.
Restricting the analyses to adults (above 16
years), the authors then predicted the time between infection and
CD4 cell counts of <200, <350, and <500
cells/mm3 being reached, as well as the proportions
reaching these thresholds at 1, 2, and 5 years after infection.
The authors estimated that CD4 cell counts
<500, <350, and <200 cells/mm3 are reached, on
average, at approximately 1, 4, and 8 years after infection,
respectively.
They also estimated that, of 100 newly
infected people, 48, on average, would require treatment within 1
year of infection if they were to follow guidelines indicating
treatment initiation at 500 cells/mm3. This is compared
with 27 and 9 individuals requiring treatment if they were to
follow guidelines advising them to start at 350 and 200
cells/mm3, respectively.
These results provide support for public
health campaigns to encourage early testing and diagnosis
particularly in targeted populations at an increased risk of HIV
infection,
to
Sara Lodi - Lead author
enable those who are HIV positive to initiate
therapy at the optimum time.
However, they also emphasise the greater
number of HIV positive people who will need to be treated. The lead
author, Sara Lodi, concludes:
“Given the substantial increase in the
number of individuals eligible for treatment as a result of the
latest changes in guidelines, it is crucial that the choice of the
CD4 cell count threshold for cART initiation is supported by
evidence of benefit from randomised controlled trials and
appropriate cost-effectiveness considerations.”
Lodi S, Phillips A, Touloumi G, Geskus R,
Meyer L, Thiébaut R, Pantazis N, del Amo J, Johnson A M, Babiker A,
Porter K on behalf of the CASCADE Collaboration in EuroCoord.
Time from HIV seroconversion to reaching CD4 thresholds <200,
<350 and <500 cells/mm3; assessment of need
following changes in treatment guidelines. Clin Infec Dis
2011;53:817-825. [PubMed]
Read more about the CASCADE
Collaboration