When to initiate highly active antiretroviral therapy in low-resource settings: The Moroccan experience

BackgroundThe aim of this study was to assess the cost-effectiveness of HIV treatment alternatives – with and without highly active antiretroviral therapy (HAART) – within alternative strata based on the CD4+T-cell count at the initiation of treatment in a low-resource setting.MethodsA retrospective observational study was conducted following 286 HIV-positive individuals admitted to the principal teaching hospital in Casablanca, Morocco, between 1995 and 2002. Patients were stratified by CD4+T-cell count and regression models were fitted to determine risk of opportunistic infection. Data on healthcare resource use were derived from patient records and were evaluated from the hospital perspective.ResultsHAART led to a significant reduction in the number of HIV-related opportunistic infections ( P+T-cell count 3, but this increased to nearly three times GDP per capita when HAART was initiated at CD4+T-cell counts above this threshold.ConclusionsHAART is more cost-effective than treating HIV-related opportunistic infections and, contrary to conclusions drawn in developed countries, HAART is more cost-effective when the CD4+T-cell count drops to 3.