How Can Earlier Entry of Patients into Antiretroviral Programs in Low-Income Countries Be Promoted?

We agree with Lawn and Wood that patients should be enrolled earlier into antiretroviral treatment (ART) programs. This will benefit HIV-infected individuals and speed up the antiretroviral "rollout" process. Starting ART before patients develop opportunistic infections prevents unnecessary deaths reduces drug interactions between the antiretrovirals and other drugs and probably decreases the incidence of immune reactivation inflammatory syndrome. The cost of these complications with their attendant hospitalization is substantial and these resources are better used for ART. To start ART earlier CD4+ lymphocyte counts must be available on a larger decentralized scale. This will require cheaper and simpler methods for testing CD4+ lymphocyte counts. Ideally measurement of CD4+ lymphocyte counts should be offered at voluntary counseling and testing sites antenatal clinics and tuberculosis (TB) treatment centers. (excerpt)