Testing but not treating: missed opportunities and lost lives in the South African ART programme

Abstract

Recently published WHO guidance recommends starting ART in HIV-infected adults with CD4 counts of ≤350 cells/μl [1]. There is mounting evidence that such a policy will lead to lower mortality among HIV-infected individuals [2]. Also modeling data suggests that expanded testing and earlier treatment will reduce HIV transmission [3]. In South Africa ART coverage is not meeting current needs, even using the CD4 count criteria of <200 cells/μl, and mortality early in ART programmes is high due to advanced immunosuppression at initiation [4]. Fortunately, following limited government leadership around HIV in the past, South African President Jacob Zuma has encouraged widespread HIV testing, and announced that he will undertake an HIV test [5]

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