[e-drug] New article on ARV Delivery in South Africa (cont'd)

[Suzanne Crowe <crowe@burnet.edu.au>]

E-drug: New article on ARV Delivery in South Africa (cont'd)
---------------------------------------------

In response to some of the issues raised by Richard Laing about ARV
delivery in the South African Khayelitsha program:

1. the use of CD4 (and VL) allowed them to clearly document what was
happening. Without these, they could have selected patients with symptoms
(and presumed their CD4 was low ) and treated them and noted clinical
improvement (and presumed their CD4 count improved).

2. Without a CD4 count you can clearly identify patients who will benefit
from treatment, and watch their clinical state to document response.
However, not all patients with low CD4 counts are symptomatic. By having
CD4 countsÝ it will allow you to additionally select patients whose CD4
is very low but who are asymptomatic or have relatively few symptoms...
just sitting on a time bomb for development of illness or death ....and
these patients will benefit from treatment. We have all seen patients who
are well and have a CD4 count of less than 100. As they are minimally 
symptomatic or asymptomatic the CD4 will be needed to show 
improvement. This improvement may translate into longer survival.

Suzanne Crowe

Professor Suzanne Crowe
Head, AIDS Pathogenesis and Clinical Research Program
NHMRC Principal Research Fellow
Macfarlane Burnet Institute for Medical Research and Public Health
Commercial Road, Melbourne, Victoria
GPO Box 2284, Melbourne,Victoria  3001, Australia
Tel: +61 3 9282 2194
Fax: +61 3 9282 2142
E-mail: crowe@burnet.edu.au

Access Essential Drugs Monitor #32 at http://www.who.int/medicines/mon/mon32.shtml

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