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Short-Term Risk of AIDS or Death in People Infected With HIV-1 Before Antiretroviral Therapy in South Africa: A Longitudinal Study

November 3, 2006

Motasim Badri of the Desmond Tutu HIV Centre at the University of Cape Town in Cape Town, South Africa, and colleagues examined 1,399 HIV-positive people residing in Cape Town who had no access to antiretroviral drugs or who were receiving zidovudine only and cohorts of HIV-positive Europeans and Australians at similar clinical stages of the disease to determine when antiretroviral therapy should begin in resource-limited settings (Badri et al., Lancet, 10/7). The study noted that current World Health Organization guidelines, which recommend that HIV-positive people in lower-income countries begin antiretroviral treatment when their CD4+ T cell counts fall below 200, are based on studies carried out in high-income countries (SAPA/Business Day, 10/30). The study found that the Cape Town residents with CD4+ T cell counts of less than 200 or greater than 350 had a similar six-month risk of progression to AIDS to those in the European and Australian cohorts. However, for participants in Cape Town with CD4+ T cell counts between 200 and 350, the risk of progressing to AIDS was 1.9 times greater, compared with the European and Australian cohorts. "The high death rate before development of AIDS and a high risk of AIDS in those with CD4 cell counts of 200 to 350 cells ... indicate that delay in initiation of [antiretroviral therapy] is associated with increased morbidity and mortality," the researchers write, concluding, "These findings might help to amend criteria for start of ART in resource-limited settings" (Badri et al., Lancet, 10/7).

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