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OR
95% CI
P-value
HIV associated
illness
Pulmonary TB
PCP
Cryptococcal
Toxoplasmosis
3.52
4.47
6.98
2.57
1.96-6.32
2.67-7.51
4.1-11.97
1.27-5.2
<0.001
<0.001
<0.001
0.01
7.84
1.61-38.22
0.01
Co-infection
HCV
HPTN 052
1,750 heterosexual serodiscordant couples in resourceconstrained countries randomized to receive ART early
(CD4 350-550 cells/L) or defer until CD4 < 250 cells/L
Event Rates
Early ART
Deferred ART
HR
P-value
Transmission Rate
per 100 pt-years
(95% CI)
0.3
(0.1-0.6)
2.2
(1.6-3.1)
0.11
(0.04-0.32)
< 0.001
2.4
(1.7-3.3)
4.0
(3.5-5.0)
0.59
(0.40-0.88)
<0.001
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC,Kumarasamy N et al, NEJM, 2011
Summary of Changes in
Recommendations in WHO 2013 ART
Guidelines-When to Start in Adults
Low-income
2002
2009
Lower middleincome
2002
2009
Upper middleincome
2002
Year of starting
ART
2009
High-income
2002
2009
Source: UNAIDS.
Conclusions
Global progress on scale-up of ART has been extraordinary- 15
millions on ART.
Decrease in morbidity and mortality
Declining incidence of HIV
Sustainability of ARVs-This will require forward-looking
policies, more effective and innovative approaches, together
with further investments
Prevention of transmission of resistance strains
Prevention and management of NCDs
ARVs for treatment and prevention are a powerful tool towards
ending the HIV epidemic