In well-resourced countries of the North the threshold is generally <350, and there is discussion of raising this level even higher. In poorly resourced countries of the South, including economic giant South Africa, it is recommended that treatment begins after someone's CD4 count dips below 200 cells/mm3.
During my recent trip to Kimberly I learnt that in South Africa, delays in initiating treatment mean that the average starting point of ARV therapy is a CD4 count of 87 cells/mm3. Dr Francois Venter, of the Southern African HIV Clinicians Society, remarked that patients in his Johannesburg clinic commence treatment at a CD4 count of 80-100 cells/mm3, a level that has not changed in four years. A study in two Durban clinics found most patients were tested at a late stage of infection with over 60 percent of CD4 counts below 200 cells/mm3. Of these patients just 42 percent had begun treatment within 12 months. The late stage at which people with HIV and AIDS in South Africa are diagnosed and the subsequent delay in getting the sufferers onto treatment has devastating consequences. Of those who were eligible for treatment, more than a fifth died, mostly before beginning treatment.
