Guideline

Southern African HIV Clinicians Society adult antiretroviral therapy guidelines: Update on when to initiate antiretroviral therapy

Graeme Meintjes, John Black, Francesca Conradie, Sipho Dlamini, Gary Maartens, Thandekile C. Manzini, Moeketsi Mathe, Michelle Moorhouse, Yunus Moosa, Jennifer Nash, Catherine Orrell, Francois Venter, Douglas Wilson
Southern African Journal of HIV Medicine | Vol 16, No 1 | a428 | DOI: https://doi.org/10.4102/sajhivmed.v16i1.428 | © 2015 Graeme Meintjes, John Black, Francesca Conradie, Sipho Dlamini, Gary Maartens, Thandekile C. Manzini, Moeketsi Mathe, Michelle Moorhouse, Yunus Moosa, Jennifer Nash, Catherine Orrell, Francois Venter, Douglas Wilson | This work is licensed under CC Attribution 4.0
Submitted: 20 October 2015 | Published: 03 December 2015

About the author(s)

Graeme Meintjes, Department of Medicine and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
John Black, Department of Medicine, Livingstone Hospital, South Africa
Francesca Conradie, Right to Care and Clinical HIV Research Unit, University of Witwatersrand, South Africa
Sipho Dlamini, Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa
Gary Maartens, Division of Clinical Pharmacology, University of Cape Town, South Africa
Thandekile C. Manzini, Department of Infectious Diseases, King Edward VIII Hospital, University of KwaZulu-Natal, South Africa
Moeketsi Mathe, Private practice, Vereeniging, South Africa
Michelle Moorhouse, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
Yunus Moosa, Department of Infectious Diseases, University of KwaZulu-Natal, South Africa
Jennifer Nash, Amathole District Clinical Specialist Team, Eastern Cape, South Africa
Catherine Orrell, Desmond Tutu HIV Foundation, University of Cape Town, South Africa
Francois Venter, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
Douglas Wilson, Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, South Africa


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Abstract

The most recent version of the Southern African HIV Clinicians Society’s adult antiretroviral therapy (ART) guidelines was published in December 2014. In the 27 August 2015 edition of the New England Journal of Medicine, two seminal randomised controlled trials that addressed the optimal timing of ART in HIV-infected patients with high CD4 counts were published: Strategic timing of antiretroviral therapy (START) and TEMPRANO ANRS 12136 (Early antiretroviral treatment and/or early isoniazid prophylaxis against tuberculosis in HIV-infected adults). The findings of these two trials were consistent: there was significant individual clinical benefit from starting ART immediately in patients with CD4 counts higher than 500 cells/μL rather than deferring until a certain lower CD4 threshold or clinical indication was met. The findings add to prior evidence showing that ART reduces the risk of onward HIV transmission. Therefore, early ART initiation has the public health benefits of potentially reducing both HIV incidence and morbidity. Given this new and important evidence, the Society took the decision to provide a specific update on the section of the adult ART guidelines relating to when ART should be initiated.

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