Stover John, Bollinger Lori, Avila Carlos
Futures Institute, 41-A New London Turnpike, Glastonbury, CT 06033, USA.
AIDS Res Treat. 2011;2011:738271. doi: 10.1155/2011/738271. Epub 2010 Nov 29.
In July 2010, WHO published new recommendations on providing antiretroviral therapy to adults and adolescents, including starting ART earlier, usually at a CD4 count of 350 or lower, specific regimens for first- and second-line therapies, and other recommendations. This paper estimates the potential impact and cost of the revised guidelines by first, calculating the number of people that would be in need of antiretroviral therapy (ART) with different eligibility criteria, and second, calculating the costs associated with the potential impact. Results indicate that switching the eligibility criterion from CD4 count <200 to <350 increases the need for ART in low- and middle-income countries (country-level) by 50% (range 34% to 70%). The costs of ART programs only to increase coverage to 80% by 2015 would be 44% more (range 29% to 63%) when switching the eligibility criterion to CD4 count <350. When testing and outreach costs are included, total costs increase by 62%, from US$26.3 billion under the previous eligibility criterion of treating those with CD4 <200 to US$42.5 billion using the revised eligibility criterion of treating those with CD4 <350.
2010年7月，世界卫生组织发布了关于为成人和青少年提供抗逆转录病毒疗法的新建议，包括更早开始抗逆转录病毒治疗（通常是在CD4细胞计数为350或更低时开始）、一线和二线治疗的具体方案以及其他建议。本文通过首先计算在不同资格标准下需要抗逆转录病毒疗法（ART）的人数，其次计算与潜在影响相关的成本，来估计修订后的指南的潜在影响和成本。结果表明，将资格标准从CD4细胞计数<200改为<350，会使低收入和中等收入国家（国家层面）对抗逆转录病毒疗法的需求增加50%（范围为34%至70%）。当将资格标准改为CD4细胞计数<350时，到2015年将抗逆转录病毒疗法项目的覆盖率仅提高到80%的成本将增加44%（范围为29%至63%）。如果将检测和推广成本计算在内，总成本将增加62%，从之前治疗CD4<200者的资格标准下的263亿美元增加到采用治疗CD4<350者的修订资格标准下的425亿美元。
