HIV Prevention and Treatment for South African Men Who Have Sex with Men (Issues IN Medicine) (Report)

HIV Prevention and Treatment for South African Men Who Have Sex with Men (Issues IN Medicine) (Report)

Initiating antiretroviral therapy (ART) at a CD4 cell count of 350 cells/[micro]l has better outcomes than postponing treatment until more immune system damage has occurred, (1) an opinion endorsed in expert guidelines from the World Health Organization, US Public Health and other academic institutions. (2,3) Some experts have motivated for even earlier ART initiation (CD4 count [less than or equal to] 500 cells/ul) to improve patient outcomes and to lower viral loads in communities to decrease HIV transmission events, a strategy known as ‘treatment as prevention’. (4) Better ART drugs and a rapid drug development pipeline favour earlier introduction of treatment. Until recently, the South African ART guidelines diverged from world opinion in delaying initiation in HIV-positive adults who are not pregnant or tuberculosis (TB) co-infected until a CD4 count of 200 cells/[micro]l was reached. (5) The South African Government (SAG) has recently announced that it will raise the CD4 threshold to 350 cells/[micro]l for all HIV-positive clients accessing state facilities for sponsored ART. This should be applauded and will provide an opportunity to lower transmission rates at community level, especially in groups who have the highest risk for HIV transmission, including men who have sex with men (MSM), commercial sex workers (CSWs), substance abusers, particularly intravenous drug users (IDUs), and serodiscordant couples. Modelling studies demonstrate that targeted programmes addressing HIV among MSM positively impact on overall HIV rates in countries with generalised epidemics. (6) The Soweto Men’s Study showed that 50% of African MSM participants also had sex with women, and high rates of HIV among MSM could be driving HIV incidence in South African women. (7) All South Africans might therefore benefit from an immediate move to initiate MSM on ART at a CD4 count of 350 cells/ [micro]l.

HIV Prevention and Treatment for South African Men Who Have Sex with Men (Issues IN Medicine) (Report)



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