Should ART be used as PMTCT in women with higher CD4 cell counts?
While the Taha study found no significant effect of ART in such women, the KiBS study did find that maternal ART reduced MTCT during breastfeeding, regardless of whether the mothers’ CD4 counts qualified them for treatment. Nevertheless, women with lower CD4 cell counts – below 350 cells/mm3, and most especially below 200 cells/mm3 – are at much higher risk of transmitting HIV to their infants, as well as risk of disease themselves – than women with higher counts (as demonstrated by the Zambia Exclusive Breastfeeding Study (ZEBS) and other studies.) The cold realities of practical constraints might argue for the strategic use of treatment where it will have the most effect. However, this should not be used as an argument for failing to treat as many people as resources permit.
