oa Southern African Journal of Epidemiology and Infection - What is the optimal CD4 count to start antiretrovirals in HIV-infected adults? : editorial



The World Health Organization (WHO) released new HIV guidelines in December 2009, calling for, amongst other criteria, initiation of antiretroviral therapy (ART) at an unqualified CD4 count of 350 cells/ul or below. This bar shift brings WHO into line with local and international treatment guidelines. President Jacob Zuma, in his World AIDS Day address, has committed government to raising the initiation threshold to 350, albeit only for pregnant women and those with tuberculosis. A Department of Health proposal to give access to all patients with a CD4 count less than 350 is currently being analysed for affordability. South Africa has by far the largest ART programme in the world by numbers, and alterations in treatment guidelines can have far ranging consequences for the country's health system.


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