Community views: balancing the public health benefits of earlier antiretroviral treatment with the implications for individual patients – perspectives from the community

Year: 2014
Journal: Current Opinion on HIV/AIDS
Volume: 9
Issue: 1
Pages: 4-10
DOI: DOI:10.1097/COH.0000000000000024
Abstract:
When should people with HIV start treatment? The recent momentum to initiate treatment at a CD4 cell count above 350 cells/mm3 is driven by the potential population benefits of antiretroviral treatment reducing infectiousness together with operational concerns. These are important. However, we focus on the clinical benefits and risks for the person taking treatment, and how this may vary depending on the background health setting. Recent guideline changes are based on limited evidence. Studies identify plausible benefits, but have limited follow-up and are not designed to assess the potential risks. Historical examples show that caution is warranted in the absence of data. The decision of when to start must be taken by the HIV-positive person in consultation with their health worker based on accurate information. That choice will vary depending on a person's individual health, their reason to want to treat and the resources of the health-care facility.
Link: http://www.ncbi.nlm.nih.gov/pubmed/24247668