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World J Virology. May 12, 2015; 4(2): 134-141
Published online May 12, 2015. doi: 10.5501/wjv.v4.i2.134
Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa
Sara Sardashti, Mehrnoosh Samaei, Mona Mohammadi Firouzeh, Seyed Ali Mirshahvalad, Fatemeh Golsoorat Pahlaviani, SeyedAhmad SeyedAlinaghi
Sara Sardashti, Mehrnoosh Samaei, Mona Mohammadi Firouzeh, Seyed Ali Mirshahvalad, Fatemeh Golsoorat Pahlaviani, SeyedAhmad SeyedAlinaghi, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran 14-19-733141, Iran
Author contributions: Sardashti S and SeyedAlinaghi SA made substantial contributions to conception and design of the study, review of the literature, interpretation of findings, and drafting the article; Samaei M, Firouzeh MM, Mirshahvalad SA and Pahlaviani FG contributed to integration of findings through literature review and drafting of the manuscript; Sardashti S made critical revisions; SeyedAlinaghi SA made the final approval.
Conflict-of-interest: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: SeyedAhmad SeyedAlinaghi, MD, MPhil, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran 14-19-733141, Iran. s_a_alinaghi@yahoo.com
Telephone: +98-21-66947984 Fax: +98-21-66947984
Received: October 28, 2014
Peer-review started: October 30, 2014
First decision: November 27, 2014
Revised: January 30, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 12, 2015
Abstract

New World Health Organization guidelines recommend the initiation of antiretroviral treatment (ART) for asymptomatic patients with CD4+ T-cell counts of ≤ 500 cells/mm3. Substantial reduction of human immunodeficiency virus (HIV) transmission is addressed as a major public health outcome of this new approach. Middle East and North Africa (MENA), known as the area of controversies in terms of availability of comprehensive data, has shown concentrated epidemics among most of it’s at risk population groups. Serious challenges impede the applicability of new guidelines in the MENA Region. Insufficient resources restrict ART coverage to less than 14%, while only one fourth of the countries had reportable data on patients’ CD4 counts at the time of diagnosis. Clinical guidelines need to be significantly modified to reach practical utility, and surveillance systems have not yet been developed in many countries of MENA. Based on available evidence in several countries people who inject drugs and men who have sex with men are increasingly vulnerable to HIV and viral hepatitis, while their sexual partners - either female sex workers or women in monogamous relationships with high-risk men - are potential bridging populations that are not appropriately addressed by regional programs. Research to monitor the response to ART among the mentioned groups are seriously lacking, while drug resistant HIV strains and limited information on adherence patterns to treatment regimens require urgent recognition by health policymakers. Commitment to defined goals in the fight against HIV, development of innovative methods to improve registration and reporting systems, monitoring and evaluation of current programs followed by cost-effective modifications are proposed as effective steps to be acknowledged by National AIDS Programs of the countries of MENA Region.

Keywords: Antiretroviral agents, HIV, CD4 counts, Co-infections, Regional health planning

Core tip: The main purpose of the present review was to investigate the feasibility of new World Health Organization guidelines on earlier initiation of antiretroviral treatment in resource-limited settings, specifically in the Middle East and North Africa region.