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South African Treatment Guidelines Need to Consider Viral Load, Not CD4 Count, to Achieve Greater Impact of Treatment as Prevention: Study

March 28, 2014

This article was reported by NAM aidsmap.

NAM aidsmap reported on a study in which the researchers suggest that South Africa should change its recommendation for beginning antiretroviral therapy (ART) to get maximum benefit from treatment as prevention (TasP) by initiating treatment early regardless of CD4 count. In South Africa, guidelines dictate that ART begins with a CD4 count of 350 cells per cubic millimeter (mm3). The researchers contend that data from previous studies, including interim data from the PARTNER study, have shown that HIV-positive individuals with suppressed viral load in serodiscordant relationships did not transmit the virus to partners, and that even with a high CD4 cell count, HIV-positive persons may have infectious levels of viral load.

The researchers monitored CD4 count and viral load in 348 newly diagnosed individuals attending the ZAZI clinic in Soweto, South Africa. Participants' median age was 34 years and median CD4 cell count was 364 cells/mm3 (range 238–542). Of the participants, 53 percent had a CD4 cell count above the required 350, and were not eligible for ART. Participants had a median viral load of 13,000 copies per milliliter (ml), and females had significantly lower median viral loads than males. Of the participants, 54 percent (64 percent of men and 48 percent of women) had a viral load higher than 10,000 copies/ml. Of the 183 participants who did not qualify for ART because of their high CD4 count, 34 percent had a viral load higher than 10,000 copies/ml.

Researchers noted that a large number of participants did not meet the guidelines for beginning ART, but had high viral loads. They concluded that based on the data, for TasP to be successful, the guidelines for initiating ART should be revised and patients begin ART regardless of CD4 counts.

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