Antiretroviral therapy initiation criteria in low resource settings – from ‘when to start’ to ‘when not to start’
Commentary from AIDS supplement: 2013 WHO Consolidated Guidelines on the use of Antiretroviral drugs: Evidence and Implementation
By the end of 2012, the number of people receiving antiretroviral treatment (ART) in lowand middle-income countries reached 9.7 million, including 7.2 million in sub-Saharan Africa. [...] 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. 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.