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Commentary antiretroviral therapy initiation criteria in low resource settings – from ‘when to start’ to ‘when not to start’.

14 ноября, 2016


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By the end of 2012, the number of people receiving antiretroviral treatment (ART) in low and middle-income countries reached 9.7 million, including 7.2 million in sub-Saharan Africa. The bad news is that these figures represent only 65% of the global target of 15 million people on ART set for 2015, and 63% of those in need of ART, therefore, excluding nearly one-third of eligible persons from a life-saving treatment. The good news is that this 2012 ART coverage figure represents an 11% increase since 2011, and a three-fold increase since 2007. As a result of government efforts and international funds, the gap between ART needs and resources is steadily decreasing.

Progress in access to ART should be measured not only in terms of eligible patients who have not yet started ART, but also based on mortality among patients who actually started ART. In resource-constrained settings, early mortality in adults who start ART ranges from 7 to 16%, a rate considerably higher than that observed in high-income countries [2–5]. The main factors associated with early mortality on ART are male sex, anemia, low body mass index (BMI), positive serum cryptococcal antigen, having to pay for the drugs, advanced clinical stage, ongoing active tuberculosis at ART initiation, and advanced immunosuppression [2–6]. It is because of the latter three reasons that WHO immunological and clinical criteria for starting ART have been revised twice in the past 3 years.

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