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WHO has released new treatment guidelines recommending ART start at CD4 cell count of 500, and treatment at any CD4 cell count level for the following groups: those with active TB (existing recommendation); Hepatitis B infection and severe chronic liver disease; HIV-positive partners in serodiscordant couples (existing recommendation); pregnant and breastfeeding women; and children younger than 5 years of age.
Would be interesting to hear how countries will transition over to these new recommendations given issues of cost, infrastructure, and human resource constraints etc. Also curious to hear thoughts of those that implement concerning potential challenges etc.

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Mukhtar Adeiza
Replied at 2:07 PM, 1 Jul 2013

Thanks Pamela. This is interesting and i guess it was always going to come based on the current level of evidence. For sub-Saharan Africa this will be a big challenge. Currently half of patients eligible for HAART using a CD4 cut off count of 350cells/ml are underserved and this is purely because of disparity between new infections and available resources. See an editorial i wrote in Annals of Nigerian Medicine in December 2012 ( We will wait and see how the policy makers in developing countries will adopt/transit to this recommendations.

Mohamed Bailor Barrie
Replied at 1:47 AM, 2 Jul 2013

Interesting, we were discussing this issue just last month in Sierra Leone, we just started implementing the 2010 recommendation and now we have new recommendations. I do think it good to start ART with CD4 of 500, but would countries like Sierra Leone be able to do this considering the cost involved.

Rumidzai Mapfumo
Replied at 3:42 AM, 2 Jul 2013

This is so cool. It will be interesting as well to see how these guidelines will be incorperated into National Strategic Plans across Africa and if they will be able to comply to these looking at how difficult it has been to provide treatment at CD4 count of 350.

sulaiman Kawooya
Replied at 10:21 AM, 2 Jul 2013

yeah, the long awaited thinking seems to be exploding now,thanks to WHO this is what we have been longing for.its doesn't make any sense at all to diagnose one with HT or DM and you start him or her on drugs and yet on the subject issue of HIV you seem to buy time.yet this monster(virus) is continually damaging one's immunity.on this note therefore,its been a positive deliberation by thing for sure is that the drug budgets for many countries will definitely increase in the short run but early treatment of HIV is cost-effective in the long run.the issue isn't whether the governments will afford to buy drugs or not;saving life is the highest ethical right everybody can do.we seriously need to take on the opportunity of TasP in global perspective in abid to reduce on Global viral load(international/Public Health view).
Sulaiman kawooya ,Masaka,Uganda

Edy Nacarapa
Replied at 2:04 AM, 3 Jul 2013

Is too cool for simple use, our patients no need to change the medication regarding if they are in TB treatment or not

Pamela Marks
Replied at 9:23 AM, 3 Jul 2013

Hi all,
I have not read the guidelines as yet in detail but I am going to assume that some sort of costing was done when these recommendations were decided upon. Moreover, does anyone know what the mean CD4 count at time of diagnosis is in many countries? A few years ago when I worked as a clinician seeing HIV patients, our mean CD4 counts at time of presentation were more in the range of 200-350. I think knowing this information would also help inform what the cost implications would be for countries that will have to take on support for their programs as funding is transitioning.

Dr Kingsley Ukwaja
Replied at 5:34 PM, 5 Jul 2013

Good to know that what we are now getting towards what I consider should be the global target in the management of HIV/AIDS; i.e. "test and treat". Once HIV is confirmed, treatment should be commenced immediately irrespective of CD4 count.

Replied at 7:37 AM, 6 Jul 2013

Dear all
I just like to thank you for your great info
Ernest MUHIRWA from PIH Rwanda

Blessings Banda
Replied at 10:47 AM, 6 Jul 2013

Thanks for the great info, it has been helpful and looking forward to hear experiences of this as time goes in different settings.

Blessings, PIH Malawi

olubunmi Lawal
Replied at 1:35 PM, 6 Jul 2013

Hi All,
I wish to appreciate every one for timely information. 

Sent from Samsung Galaxy NoteErnest MUHIRWA via GHDonline <> wrote:Ernest MUHIRWA replied to a discussion in HIV Treatment & Prevention:
Dear all
I just like to thank you for your great info
Ernest MUHIRWA from PIH Rwanda

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