China Promotes the HIV "Treatment upon Detection" Strategy Without any Threshold for CD4 Count

On June 15, the National Health and Family Planning Commission issued the Notice on Adjusting Criteria for Free ART, requiring to recommend ART for all HIV-infected persons and AIDS patients, i.e. "Treatment upon Detection". Moreover, ART should follow the principle of voluntariness and must not be provided compulsively. CDCs and designated ART hospitals at all levels should further standardize ART management.

According to Zhang Fujie (leader of the AIDS Clinical Expert Panel of the National Health and Family Planning Commission and director the Infectious Center of Beijing Ditan Hospital affiliated to Capital Medical University), the criteria for free ART in China were first introduced in the National Manual for Free ART published in 2008, with the threshold of CD4 count < 200 cells/μl. The threshold was adjusted to CD4 count < 350 cells/μl in 2012 and CD4 count < 500 cells/μl in 2014. In case of such complications as cerebrovascular diseases, TB or tumor or discordant families, ART is recommended even if CD4 count > 500 cells/μl.

"The new criteria do not define any threshold for CD4 count, and implement the "Treatment upon Detection" strategy," said Zhang Fujie. More and more studies show that early treatment can not only benefit HIV-infected persons and AIDS patients, but also protect the general public with an increasing coverage of ART from the public health perspective. Over the past years, the "Treatment upon Detection" strategy has been implemented in many areas in China. Thus, the implementation of the new criteria will not lead to shortage of ARV supply or understaffing of medical workers along with an increasing number of ART clients.

Zhang Fujie emphasized that, although the coverage of ART has been significantly expanded in China, the categories of ARVs were still limited. Currently, there are over 30 ARVs in six categories in the United States, but only seven ARVs in three categories in China. "The latest ARV in China was approved for marketing in 2001 in the United States. The "National 13th Five-Year Plan" proposes to increase the categories of ARVs, but many new ARVs cannot enter China due to high costs," said Zhang Fujie. (Source: Zhang Lei, JKB.com.cn, June 20, 2016)