How Many Newly Diagnosed HIV-Positive Patients Meet Criteria for Antiretroviral Treatment or Prophylaxis against Opportunistic Infections?
In asymptomatic HIV-positive patients, viral load and CD4 cell count testing are used to determine eligibility for HAART and opportunistic infection prophylaxis.13,16 Antiretroviral therapy is currently recommended for patients with CD4 cell counts less than 0.200 x 109 cells/L. Antiretroviral therapy can also be considered for other asymptomatic patients at high risk for disease progression (CD4 cell count < 0.350 x cells 109/L or viral load > 100,000 copies/mL). Interventions are generally less effective in persons with advanced immune deficiency,109 although some benefit is seen.110,111 No studies report both CD4 cell count and viral load in newly diagnosed patients. Seven U.S. studies in different settings found that the proportion of patients with CD4 cell counts less than 0.200 x 109 cells /L at diagnosis or when establishing care ranged from 12% to 43%, and the proportion with CD4 cell counts less than 0.500 x 109 cells/L ranged from 46% to 80%.26,41,112-116 Screening could iden
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