‘Clinical monitoring of HAART is too complicated…’

  The management of people with HIV and AIDS has indeed become a highly specialised field in the West, with the choice of drugs and the range of sophisticated monitoring tests available.

  In poorer parts of the world, often where there is no doctor, it is more a case of ‘needs must’.  Appropriate and quite successful health care protocols have evolved or been developed for a whole range of diseases, that do not rely on expensive lab tests such as CD4 or viral load monitoring, which are the cornerstones of HAART management in the West.

  Since the aim would be to treat only those people with significant AIDS, a simple list of clinical criteria could be used to decide when and if to start someone on HAART.  This is the approach used by a pilot trial in Haiti (see below).  If someone is started on HAART, they will probably have to take that treatment for the rest of their life.  This should therefore be a carefully made, informed decision made on the balance of the clinical status of the patient, his/her social circumstances and the likelihood that they will be able to receive and adhere to an uninterrupted supply of tablets.  Ideally, it should be a trained health worker, working as part of a co-ordinated AIDS treatment programme, who makes this decision, together with the patient.  It does not however need to be ‘high-tech.’