The [him] moderator has permission from Thiha, the author of a comment, to use his name in this posting. In response to the posting on changing CD4 thresholds too soon, he wrote:
"That is the dumbest thing since bricks! Just how much of a house do you let burn down before you call the fire department 30%? There is overwelming evidence that a patience CD-4 T-cell nadir is predictive of their overall long-term healthful survival. There is absolutely no benifit in allowing a patients immune system to be partially destroyed before iniating anti-retro viral therapy."
The [him] moderator's reply.
In Myanmar, fires are always on our minds. But health science recommendations and firefighting recommendations are different.
New Myanmar ART guidelines have just been published. WHO last made recommendations in 2010. Please email your valuable opinion to WHO staff in Yangon and Geneva. They say they will make new guidelines this year. The new US guidelines are below. Even they say there is only 'moderate' evidence from 'expert opinion' to give ART to all people with HIV.
Jamie
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US Panel's Recommendations
Antiretroviral therapy (ART) is recommended for all HIV-infected individuals to reduce the risk of disease progression.
The strength and evidence for this recommendation vary by pretreatment CD4 cell count: CD4 count <350 cells/mm3 (AI); CD4 count 350–500 cells/mm3 (AII); CD4 count >500 cells/mm3 (BIII).
ART also is recommended for HIV-infected individuals for the prevention of transmission of HIV.
The strength and evidence for this recommendation vary by transmission risks: perinatal transmission (AI); heterosexual transmission (AI); other transmission risk groups (AIII).
Patients starting ART should be willing and able to commit to treatment and understand the benefits and risks of therapy and the importance of adherence (AIII). Patients may choose to postpone therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or psychosocial factors.
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion
