n Southern African Journal of HIV Medicine - Antiretroviral therapy in adults : March 2005 : guidelines

Volume 2005, Issue 18
  • ISSN : 1608-9693
  • E-ISSN: 2078-6751



Sub-Saharan Africa has just over 10% of the world's population but is home to more than 60% of all people living with HIV (approximately 25.4 million people). Prevalence rates in southern Africa's antenatal clinics surpass 25%, the highest in the world. <br>South Africa is host to the highest number of HIV-infected people in the world (5.3 million, UNAIDS/WHO AIDS epidemic update, December 2004) with considerable regional variation and an annual increase in all but two provinces (Free State and Gauteng). The Free State, Mpumalanga and KwaZulu-Natal have prevalence rates among pregnant women attending public sector antenatal clinics of > 30% while the remaining provinces have a range of between 15% and 17.5%. <br>Four other countries in the region have very high antenatal prevalence rates, often exceeding 40%: Botswana, Lesotho, Namibia and Swaziland (39%). Elsewhere in the sub-region HIV infections in pregnant women appear to be stabilising at lower levels, e.g. Malawi (18%), Zambia (16%) and Zimbabwe (25%). Uganda's prevalence, though still high, has dropped in the last decade to 5 - 6%. Angola is the exception in the region, having had very low prevalence levels for some years, possibly owing to the war which restricted civilian movement. Prevalence remains at about 3% at Luanda's antenatal clinics; however, sex workers have an incidence of 33%, fuelling fears of a widespread and rapid spread in this country. <br>Most sub-Saharan countries have antiretroviral roll-outs, albeit at different stages and levels of delivery. <br>In July 2004, the Health Systems Trust, reported in the first <I>South African Health Review (SAHR)&lt;/I&gt; that AIDS was responsible for 39% of deaths in South Africa in 2000. Gearing up for the national antiretroviral (ARV) roll-out in early 2003, the South African government estimated that about half a million South Africans with AIDS were in urgent need of ARV treatment (ART). In March 2003 the Department of Health commenced the national roll-out at a handful of pre-selected, designated pilot sites, aiming to treat 53 000 HIV-infected South Africans (CD4+ counts of < 200/µl) with ARVs by March 2004, and expanding the number of sites over time. To date progress has been slower than planned. National ART guideline regimens are advised in these guidelines.

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