Switch from 200 to 350 CD4 baseline count: what it means to HIV care and treatment programs in Kenya

Abstract

Introduction: With the increasing population of infected individuals in Africa and constrained resources for care and treatment, antiretroviral
management continues to be an important public health challenge. Since the announcement of World Health Organization recommendation and
guidelines for initiation of antiretroviral Treatment at CD4 count below 350, many developing countries are adopting this strategy in their country
specific guidelines to care and treatment of HIV and AIDS. Despite the benefits to these recommendations, what does this switch from 200 to 350
CD4 count mean in antiretroviral treatment demand? Methods: A Multi-centre study involving 1376 patients in health care settings in Kenya. CD4
count was carried out by flow cytometry among the HIV infected individuals in Kenya and results analyzed in view of the In-country and the new
CD4 recommendation for initiation of antiretroviral treatment. Results: Across sites, 32% of the individual required antiretroviral at <200 CD4
Baseline, 40% at <250 baseline count and 58% based on the new criteria of <350 CD4 Count. There were more female (68%) than Male
(32%).Different from <200 and <250 CD4 baseline criteria, over 50% of all age groups required antiretroviral at 350 CD4 baseline. Age groups
between 41-62 led in demand for ART. Conclusion: With the new guidelines, demand for ARVs has more than doubled with variations noted
within regions and age groups. As A result, HIV Care and Treatment Programs should prepare for this expansion for the benefits to be realized.

Key words: CD4, New criteria, HIV, AIDS, care and treatment, ARV initiation