In spite of guidelines and goals, treatment access remains delayed and unequal
Data from nearly a million patients starting treatment for HIV across the world over the last decade shows 55 percent of them accessed antiretroviral treatment only after their immune cell — or CD4 — counts had dropped below 200, leaving them extremely vulnerable to illnesses and infections, according to a study reported in Clinical Infectious Diseases. The study included data from countries across the economic spectrum, in North America, Latin America and the Caribbean, Asia-Pacific, sub-Saharan Africa and Europe.
The data represents a range, showing that by 2014 while 77 percent of patients initiating antiretroviral treatment in Senegal did not start treatment until their immune cell counts had dropped to under 200, in Switzerland that proportion was much lower, with 31 percent of patients beginning antiretroviral treatment with an immune cell count under 200.
Data varied by region and resources, while showing that immune cell counts at treatment initiation had generally and gradually risen from 2002 to 2015, but that increase has recently slowed overall. Across countries of all income levels, according to the authors, median immune cell counts for patients starting antiretroviral treatment generally remained below 350, the level set in 2009 by World Health Organization for treatment initiation. The WHO recommended in 2016 that all people with HIV start treatment immediately upon diagnosis, a standard that had been adopted across North America in 2012.
While continuing to lag well behind recommendations, increased immune cell counts at treatment initiation reflect guideline changes, the authors note. By 2014 the median immune cell count for patients initiating treatment had risen to 435 in North America, while the median count for those starting treatment in West Africa was 186 that year.
The authors note that investments in HIV testing access, from the U.S. President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS Tuberculosis and Malaria, as well as increased investments in preventing mother to child transmission of HIV with testing and treatment access in prenatal care sites have played roles in getting treatment to patients earlier in the progression of the virus. But, they add, to reach 2020 targets projected for control of the pandemic — for 90 percent of people with HIV to be aware of their infection, 90 percent of those infected to be on treatment and for treatment to be suppressing the virus in 90 percent of those receiving it — efforts and investments will need to increase greatly.