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In resource-rich settings, the debate surrounding the best time to start antiretroviral therapy (ART) centers on issues of viral resistance and patient adherence. In resource-poor environments, where the question is more critical because of increased rates of opportunistic infection, another factor must be considered: the cost-benefit of treating additional patients. Although clinical trials are under way to examine the optimal timing of ART in such settings, the results will not be available for several years. How should HIV treatment decisions be made until then?
Using data from randomized trials and observational cohorts in South Africa, researchers created a computer model to compare morbidity, mortality, and costs among three strategies…