Editorial
HIV treatment outcomes in Europe and North America: what can we learn from the differences? Expert Review of Anti-infective Therapy Downloaded from informahealthcare.com by Nyu Medical Center on 05/30/15 For personal use only.
Expert Rev. Anti Infect. Ther. 12(5), 523–526 (2014)
Juan Ambrosioni Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain and Infectious Diseases Service, University Hospitals of Geneva, Geneva, Switzerland
David Nicolas Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
Fernando Agu¨ero Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
Christian Manzardo Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
Jose M Miro Author for correspondence: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain Tel.: +34 932 275 586; +34 619 185 402 Fax: +34 934 514 438 [email protected]
The access to antiretroviral treatment has been largely enlarged in Europe and North America in recent years, due to treatment guidelines that recommend earlier initiation of therapy. However, there are differences and heterogeneities in the health systems and in access and retention to care between different countries and regions, and for different subpopulations among the same country that impact in the final goal, that patients remain undetectable and in good health.
Access to antiretroviral treatment has been considerably extended in Europe and North America in recent years as a result of treatment guidelines that recommend earlier initiation of therapy. However, differences between health systems and variations in access to and retention in care between different countries and regions and between subpopulations in the same country severely affect the primary objectives of treatment, namely, that viral load remain undetectable and patients maintain good health. We discuss the situation in North America and Europe (defined geographically as northern, southern, western and eastern according to WHO [1]). Differences in recommendations for antiretroviral treatment in guidelines
Treatment guidelines for HIV infection have recently been published in the USA [2,3] and Europe [4]. While consistent in most of their recommendations, they differ with respect to the indication for initiation of antiretroviral therapy (ART) in less immunocompromised patients. The guidelines of the Division of Health and Human Services [2] and the International AIDS Society [3] propose universal treatment, independent of CD4 count. In this context, the guidelines of the
European AIDS Clinical Society are much more conservative: treatment is recommended for patients with 350 cells/ml (and >500 cells/ml) when one of a series of different conditions are present (e.g., advanced age and coinfection with hepatitis C virus or hepatitis B virus) [4]. Such a conservative approach is surprising; for instance, the WHO guidelines, which have a much more ‘public health’ approach, recommend treatment for individuals with
HIV treatment outcomes in Europe and North America: what can we learn from the differences? Expert Review of Anti-infective Therapy Downloaded from informahealthcare.com by Nyu Medical Center on 05/30/15 For personal use only.
Expert Rev. Anti Infect. Ther. 12(5), 523–526 (2014)
Juan Ambrosioni Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain and Infectious Diseases Service, University Hospitals of Geneva, Geneva, Switzerland
David Nicolas Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
Fernando Agu¨ero Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
Christian Manzardo Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
Jose M Miro Author for correspondence: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain Tel.: +34 932 275 586; +34 619 185 402 Fax: +34 934 514 438 [email protected]
The access to antiretroviral treatment has been largely enlarged in Europe and North America in recent years, due to treatment guidelines that recommend earlier initiation of therapy. However, there are differences and heterogeneities in the health systems and in access and retention to care between different countries and regions, and for different subpopulations among the same country that impact in the final goal, that patients remain undetectable and in good health.
Access to antiretroviral treatment has been considerably extended in Europe and North America in recent years as a result of treatment guidelines that recommend earlier initiation of therapy. However, differences between health systems and variations in access to and retention in care between different countries and regions and between subpopulations in the same country severely affect the primary objectives of treatment, namely, that viral load remain undetectable and patients maintain good health. We discuss the situation in North America and Europe (defined geographically as northern, southern, western and eastern according to WHO [1]). Differences in recommendations for antiretroviral treatment in guidelines
Treatment guidelines for HIV infection have recently been published in the USA [2,3] and Europe [4]. While consistent in most of their recommendations, they differ with respect to the indication for initiation of antiretroviral therapy (ART) in less immunocompromised patients. The guidelines of the Division of Health and Human Services [2] and the International AIDS Society [3] propose universal treatment, independent of CD4 count. In this context, the guidelines of the
European AIDS Clinical Society are much more conservative: treatment is recommended for patients with 350 cells/ml (and >500 cells/ml) when one of a series of different conditions are present (e.g., advanced age and coinfection with hepatitis C virus or hepatitis B virus) [4]. Such a conservative approach is surprising; for instance, the WHO guidelines, which have a much more ‘public health’ approach, recommend treatment for individuals with
