When to start ART in Africa.
When to start ART in Africa.
复制标题
何时在非洲开始 ART。
DOI：
10.1056/nejmc1304494
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
El-Sadr,WafaaM
中科院分区：
文献类型：
--
作者：
DeCock,KevinM;El-Sadr,WafaaM
To the Editor: In their Perspective article, De Cock and El-Sadr (March 7 issue) 1 highlight the need for data on when to start antiretroviral therapy (ART) for HIV-infected people in Africa who have CD4+ counts above 350 cells per cubic millimeter. However, their proposed solution—a new randomized, controlled trial in Africa—is flawed. First, before a new randomized, controlled trial could commence in Africa, data from the Strategic Timing of Antiretroviral Treatment (START) trial (ClinicalTrials. gov number, NCT00867048), the Early Antiretroviral Treatment and/or Early Isoniazid Prophylaxis Against Tuberculosis in HIV-Infected Adults (TEMPRANO) trial (NCT00495651), and the Evaluating Strategies to Reduce Mother-to-Child Transmission of HIV Infection in Resource-Limited Countries (PROMISE) trial (NCT01061151) will most likely disturb the equipoise that arguably exists today.Second, although the authors argue that African populations have more coexisting conditions than other populations, patients with coexisting conditions may derive greater benefit from early treatment. 2 Therefore, a new trial in Africa might contribute little if other studies show a significant benefit from earlier ART. Finally, the authors acknowledge that millions of people do not receive ART as recommended by guidelines based on current data. This lack of treatment may be due to fiscal constraints and lack of capacity in the health system; implementation research could better identify strategies for earlier linkage to treatment or for building such capacity. Most important, sustainable funding for treating people with HIV who we know require such treatment for their health is more urgently needed than an additional randomized, controlled trial on when to start ART in Africa.
