From Johns Hopkins: Universal Antiretroviral Therapy for HIV Infection: Should U.S. Treatment Guidelines Be Applied to Resource-Limited Settings?

http://www.ncbi.nlm.nih.gov/pubmed/23759345

Clin Infect Dis. 2013 Jun 11. [Epub ahead of print]

Universal Antiretroviral Therapy for HIV Infection: Should U.S. Treatment Guidelines Be Applied to Resource-Limited Settings?

Gallant JE, Mehta SH, Sugarman J.

Source

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Abstract

U.S. treatment guidelines now recommend antiretroviral therapy (ART) for all HIV-infected patients, regardless of CD4 count, both for the benefit of infected individuals and to prevent HIV transmission. In effort to meet the critical goal of treating all HIV-infected persons worldwide, there is movement towards extrapolating these guidelines and the data supporting them to resource-limited settings. While economic and practical barriers to universal ART are widely recognized, there has been little discussion of the ethical considerations resulting from global disparities in the safety and efficacy of universal ART in these settings. We argue that the risk-benefit considerations for initiating ART are not the same worldwide due to limitations in the ART regimens used, laboratory monitoring, and consistent availability of ART, which raise ethical questions about universally applying U.S. guidelines in resource-limited settings at the present time.