Table 3.
Evolving criteria for ART initiation and ART monitoring in South Africa from 2004 to 2016
Year | Guidelines | ART initiation criteria/CD4 and VL monitoring |
2004 | National ARV Treatment Guidelines (2004)36 | Criteria for ART initiation CD4 <200 cells/mm3 irrespective of stage or WHO stage IV AIDS-defining illness, irrespective of CD4 count, and patient expresses willingness and readiness to take ART adherently ART monitoring CD4: staging and every 6 months VL: staging and every 6 months |
2010 | The South African Antiretroviral Treatment Guidelines 201037 | Criteria for ART initiation CD4 count <200 cells/mm3 irrespective of clinical stage or CD4 count <350 cells/mm3 in patients with TB/HIV or pregnant women or WHO stage IV irrespective of CD4 count or MDR/XDR irrespective of CD4 Require fast track (ie, ART initiation within 2 weeks of being eligible) Pregnant women eligible for lifelong ART, patients with very low CD4 (<100) Stage 4, CD4 count not yet available MDR/XDR TB ART monitoring CD4: staging, 6 and 12 months and annually thereafter VL: 6 and 12 months and annually thereafter |
2011 | Circular on New Criteria for Initiation of Adults on ART at CD4 Count of 350 cells/mm3 and below, 26 August 2011 | Baseline CD4 for initiation at CD4 <350 cells/mm3 |
2012 | Accelerating Access to ART Services and Uptake (circular), 17 April 2012 | Criteria for ART initiation CD4 count <350 cells/mm3 irrespective of clinical stage or patients with TB/HIV irrespective of CD4 count or pregnant women or WHO stage IV irrespective of CD4 count or MDR/XDR irrespective of CD4 Require fast track (ie, same day ART initiation) Pregnant women eligible for lifelong ART, patients with low CD4 (<200) Stage 4, CD4 count not yet available MDR/XDR TB Screening and treatment of patients with very low CD4 counts (<100) for cryptococcal infection ART monitoring CD4: staging, 12 months and annually thereafter VL: 6 and 12 months and annually thereafter |
2013 | The South African Antiretroviral Treatment Guidelines 201338 | Criteria for ART initiation CD4 count <350 cells/mm3 irrespective of WHO clinical stage or irrespective of CD4 count and all types of TB (In patients with TB drug resistance or sensitivity, including extrapulmonary TB) and WHO stage 3 or 4 irrespective of CD4 count Require fast track (ie, ART initiation within 7 days of being eligible) HIV-positive women who are pregnant or breast feeding or patients with low CD4 <200 or patients with stage 4, irrespective of CD4 count or patients with TB/HIV comorbidity with CD4 count <50 (patients with Cryptococcus meningitis or TB meningitis (defer ART for 4–6 weeks) ART monitoring CD4: staging and 1 year VL: 6 and 12 months and annually thereafter |
2015 | National Consolidated Guidelines for the Prevention of Mother-to-Child Transmission of HIV and the Management of HIV in Children, Adolescents and Adults 201539 | Criteria for ART initiation CD4 count<500 cells/mm3 irrespective of WHO clinical stage or all types of TB or WHO stage 3 or 4 or HBV coinfection irrespective of CD4 count Immediate initiation All HIV-positive pregnant or breastfeeding women, as long as no active TB Require fast track (ie, ART initiation within 7 days of being eligible) Patients with low CD4 <200 or patients with stage 4, irrespective of CD4 count ART monitoring CD4: staging and 1 year VL: 6 and 12 months and annually thereafter |
2016 | Circular on Implementation of the Universal Test and Treat Strategy for HIV Positive Patients and Differentiated Care for Stable Patients, 22 August 201640 | Criteria for ART initiation All HIV-positive adolescents and adults regardless of CD4 count ART monitoring CD4 staging and 1 year VL monitoring at 6 and 12 months and annually thereafter |
ART, antiretroviral therapy; TB, tuberculosis; VL, viral load.