Correspondence
been dazzled by a medical model of unproven benefit. We declare that we have no conflicts of interest.
*Mary T Bassett, Karen Brudney [email protected] Doris Duke Charitable Foundation, African Health Initiative, New York, NY 10019, USA (MTB); and College of Physicians and Surgeons, Columbia University, New York, NY, USA (KB) 1
2
3
4
5
Mayer K, Beyrer C. WHO’s new HIV guidelines: opportunities and challenge. Lancet 2013; 382: 287–88. Kim JY, Farmer P, Porter ME. Redefining global health-care delivery. Lancet 2013; 382: 1060–69. Duncombe C, Ball A, Passarelli C, Hirnschall G. Treatment 2.0: catalyzing the next phase of treatment, care and support. Curr Opin HIV AIDS 2013; 8: 4–11. Bangkok Post. Government frets over new HIV treatment costs. WHO broadens scope in new guideline. July 1, 2013. http://www. bangkokpost.com/news/local/357658/ new-hiv-treatment-guidelines-are-a-budgetburden (accessed July 31, 2013). De Cock KM, El-Sadr WM. When to start ART in Africa—an urgent research priority. N Eng J Med 2013; 368: 886–89.
The WHO guidelines for HIV treatment have been amended to start antiretroviral treatment (ART) at CD4 cell counts of 500 cells per μL or below (rather than 350) to reduce disease progression and transmission.1,2 By contrast, the test-and-treat model
Probability of eligibility for ART
0·8
*Patricia E Fast, Matt A Price, Wasima N Rida, Anatoli Kamali, Etienne Karita, on behalf of the International AIDS Vaccine Initiative (IAVI) African Early Infection Research
0·6
Group (for the IAVI Group, see appendix) 0·4
[email protected]
0·2
0 Number at risk Men I Women I Men II Women II
0
0·5
1·0 Years since EDI
1·5
2·0
327 227 327 227
139 113 171 137
81 71 115 106
55 53 94 80
39 39 70 59
Figure: Probability of individuals to be eligible for ART, by years since EDI Kaplan-Meier curves for endpoint I (time to first CD4 count ≤500 cells per μL) and endpoint II (time to first of two consecutive CD4 count ≤500 cells per μL) in men and women enrolled within 6 months of their EDI. ART=antiretroviral treatment. EDI=estimated date of HIV infection.
1778
count within about 3 months. CD4 counts prior to 3 months post-EDI were excluded because CD4 cell count frequently drops then rebounds after acute infection. Individuals were censored at last visit prior to onset of antiretroviral therapy. 18 participants initiated ART before reaching CD4≤500 and thus were censored. 50% of newly infected African men reached CD4≤500 cells per μL within 6 months (IQR 3–13 months), using the definition of one CD4 count ≤500 cells per μL. Women reached eligibility later with a median time of 8 months (IQR 3–23 months; log-rank p
been dazzled by a medical model of unproven benefit. We declare that we have no conflicts of interest.
*Mary T Bassett, Karen Brudney [email protected] Doris Duke Charitable Foundation, African Health Initiative, New York, NY 10019, USA (MTB); and College of Physicians and Surgeons, Columbia University, New York, NY, USA (KB) 1
2
3
4
5
Mayer K, Beyrer C. WHO’s new HIV guidelines: opportunities and challenge. Lancet 2013; 382: 287–88. Kim JY, Farmer P, Porter ME. Redefining global health-care delivery. Lancet 2013; 382: 1060–69. Duncombe C, Ball A, Passarelli C, Hirnschall G. Treatment 2.0: catalyzing the next phase of treatment, care and support. Curr Opin HIV AIDS 2013; 8: 4–11. Bangkok Post. Government frets over new HIV treatment costs. WHO broadens scope in new guideline. July 1, 2013. http://www. bangkokpost.com/news/local/357658/ new-hiv-treatment-guidelines-are-a-budgetburden (accessed July 31, 2013). De Cock KM, El-Sadr WM. When to start ART in Africa—an urgent research priority. N Eng J Med 2013; 368: 886–89.
The WHO guidelines for HIV treatment have been amended to start antiretroviral treatment (ART) at CD4 cell counts of 500 cells per μL or below (rather than 350) to reduce disease progression and transmission.1,2 By contrast, the test-and-treat model
Probability of eligibility for ART
0·8
*Patricia E Fast, Matt A Price, Wasima N Rida, Anatoli Kamali, Etienne Karita, on behalf of the International AIDS Vaccine Initiative (IAVI) African Early Infection Research
0·6
Group (for the IAVI Group, see appendix) 0·4
[email protected]
0·2
0 Number at risk Men I Women I Men II Women II
0
0·5
1·0 Years since EDI
1·5
2·0
327 227 327 227
139 113 171 137
81 71 115 106
55 53 94 80
39 39 70 59
Figure: Probability of individuals to be eligible for ART, by years since EDI Kaplan-Meier curves for endpoint I (time to first CD4 count ≤500 cells per μL) and endpoint II (time to first of two consecutive CD4 count ≤500 cells per μL) in men and women enrolled within 6 months of their EDI. ART=antiretroviral treatment. EDI=estimated date of HIV infection.
1778
count within about 3 months. CD4 counts prior to 3 months post-EDI were excluded because CD4 cell count frequently drops then rebounds after acute infection. Individuals were censored at last visit prior to onset of antiretroviral therapy. 18 participants initiated ART before reaching CD4≤500 and thus were censored. 50% of newly infected African men reached CD4≤500 cells per μL within 6 months (IQR 3–13 months), using the definition of one CD4 count ≤500 cells per μL. Women reached eligibility later with a median time of 8 months (IQR 3–23 months; log-rank p
