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Evidence should inform policy: Should we offer antiretroviral therapy soon after HIV diagnosis?

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"It is very easy to introduce IPT to PLHIV through ART clinics that are visited by them once every 1-2 month. Unfortunately, as of now we do not know as to for how long should IPT be given. In sub-Saharan Africa where there are very high rates of TB and HIV, it looks like IPT should be given for life. But one has to be careful, as isoniazid is not completely non-toxic and may affect the liver function. So regular monitoring should done at ART clinics where PLHIV have to go regularly and report side effects", cautions Dr Harries.

There seems to be enough evidence now that reinforces and confirms that an earlier start of ART at high CD4+ T cell count is safe and leads to a reduced risk of AIDS, non-AIDS related events and death, and also reduces risk of TB in PLHIV. Furthermore, the addition IPT to ART produces additional protection and further lowers the risk of TB, which only underscore the recommendations that IPT should be given with ART, once the patient is stable. Starting ART at high CD4+ T cell count has also been shown to be effective in reducing the risk of HIV transmission. So recommending all PLHIV to start ART irrespective of their CD4+ T cell count might help curb the epidemic.

Thus, starting ART soon after diagnosis of HIV infection protects people's health--it is good fro the user as well as the partner. These findings are likely to affect many countries' guidelines for when to start treatment for HIV infection and and support the option of 'Test and Treat.'

Shobha Shukla, CNS

(Follow author on Twitter: @Shobha1Shukla)

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