Scientists: test on CD4 before starting ART in poor countries could save thousands of lives

A pillar of public health in low- and middle-income countries on a resource-based approach to prescribing antiretroviral therapy for people diagnosed with HIV can save thousands of lives. These are the findings of a group of specialists from Washington University, published on the eve of the open access journal PLOS Medicine.

As one of the co-authors of the study, Mark Tenford, writes, effective antiretroviral therapy has significantly reduced the incidence and mortality from HIV infection over the past two decades.

Immediately, several randomized studies demonstrated the benefits of ART, regardless of the starting number of CD4 cells in the human body, and in 2015, the World Health Organization (WHO) adopted a strategy for “treating everyone”.

Much attention was paid to the fastest possible initiation of antiretroviral therapy after diagnosis, and there has been tremendous progress.

However, today a significant proportion of patients starting ARV therapy in low- and middle-income countries still have severe immunosuppression, and a recent laboratory analysis showed that a third of patients in South Africa seek medical care for advanced HIV. These people have the greatest risk of significant damage to immunity, the development of opportunistic infections and death.

According to Tenford and his colleagues, current strategies are not enough to detect and prevent opportunistic infections and related deaths in these patients.

In this regard, the authors propose to use the so-called resource (resource-oriented) approach based on the availability of diagnostic tests to detect opportunistic infections.

This approach, they believe, being easy to implement, will help reduce mortality among novice antiretroviral therapy.

Even with the most limited resources, funds can be found that can save thousands of lives.

Improvement of the method can take place in the context of the introduction of rapid screening for the most common opportunistic infections.

According to the authors, the optimal approach requires that early ARV treatment is still available from the results of testing on CD4 (preferably as a simple threshold test at the time of medical care).

“We believe that this will provide a pragmatic approach that avoids delaying the initiation of ARV therapy for the majority of immunocompromised patients who are most at risk of death,” the authors write.