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

  • Graeme Meintjes University of Cape Town
  • John Black Livingstone Hospital
  • Francesca Conradie University of the Witwatersrand
  • Sipho Dlamini University of Cape Town
  • Gary Maartens University of Cape Town
  • Thandekile C Manzini University of KwaZulu-Natal
  • Moeketsi Mathe
  • Michelle Moorhouse Wits Reproductive Health and HIV Institute
  • Yunus Moosa University of KwaZulu-Natal
  • Jennifer Nash
  • Catherine Orrell University of Cape Town
  • Francois Venter Wits Reproductive Health and HIV Institute
  • Douglas Wilson University of KwaZulu-Natal

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 randomized 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.

Author Biographies

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