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. 2018 Mar;22(3):1018-1024.
doi: 10.1007/s10461-017-1729-2.

Acceptability of Early Antiretroviral Therapy Among South African Women

Nigel Garrett  1 , Emily Norman  2   3 , Kerry Leask  2 , Nivashnee Naicker  2 , Villeshni Asari  2 , Nelisile Majola  2 , Quarraisha Abdool Karim  2   3 , Salim S Abdool Karim  2   3
Affiliations

Acceptability of Early Antiretroviral Therapy Among South African Women

Nigel Garrett et al. AIDS Behav. 2018 Mar.

Abstract

WHO guidelines recommend immediate initiation of antiretroviral therapy (ART) for all individuals at HIV diagnosis regardless of CD4 count, but concerns remain about potential low uptake or poor adherence among healthy patients with high CD4 counts, especially in resource-limited settings. This study assessed the acceptability of earlier treatment among HIV-positive South African women, median age at enrollment 25 (IQR 22-30), in a 10 year prospective cohort study by (i) describing temporal CD4 count trends at initiation in relation to WHO guidance, (ii) virological suppression rates post-ART initiation at different CD4 count thresholds, and (iii) administration of a standardized questionnaire. 158/232 (68.1%) participants initiated ART between 2006 and 2015. Mean CD4 count at initiation was 217 cells/µl (range 135-372) before 2010, and increased to 531 cells/µl (range 272-1095) by 2015 (p < 0.001). Median viral load at ART initiation decreased over this period from 5.2 (IQR 4.6-5.6) to 4.1 (IQR 3.4-4.6) log copies/ml (p = 0.004). Virological suppression rates at 3, 6, 12 and 18 months were consistently above 85% with no statistically significant differences for participants starting ART at different CD4 count thresholds. A questionnaire assessing uptake of early ART amongst ART-naïve women, median age 28 (IQR 24-33), revealed that 40/51 (78.4%) were willing to start ART at CD4 ≥500. Of those unwilling, 6/11 (54.5%) started ART within 6 months of questionnaire administration. Temporal increases in CD4 counts, comparable virological suppression rates, and positive patient perceptions confirm high acceptability of earlier ART initiation for the majority of patients.

Keywords: Antiretroviral therapy; CD4 count; HIV; South African women.

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Conflict of interest statement

Conflict of Interest: The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
CD4 count and viral load trends at ART Initiation in CAPRISA 002
Figure 2
Figure 2. A and B: Perceived benefits and drawbacks of earlier ART (n=51)
Tx = transmission
Figure 3
Figure 3
A and B: Acceptability of ART initiation at CD4 ≥500 (n=51)
See this image and copyright information in PMC

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