| Chapter 1: | Introduction |
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and the quality of life as based on staging of the disease are inconsistent (Gao, Nau, Rosenbluth, Scott, & Woodward, 2000). Some scholars have demonstrated that disease progression is greater in persons who start HAART with a CD4 cell count below 200 than in those starting therapy above this level (Garcia et al., 2004). However, Wood et al. (2003) compared benefits of HAART for individuals whose CD4 cell count was between 200 and 350 with those of persons whose CD4 cell count was below 200 and found that both groups equally benefited from treatment. Nevertheless, regardless of available information about when to initiate anti-HIV drugs, HAART initiation in Uganda (unlike in the United States) strictly follows the WHO guidelines and is based on clinical and immunological assessments, such as CD4 cell count and the manifestation of specific HIV/AIDS opportunistic illnesses as discussed later (WHO, 2003a; WHO, 2008c). For example, according to WHO (2004), free access to HAART in resource-constrained nations may only be initiated under one of three conditions. The first condition is a CD4 cell count of 200 or below, regardless of HIV disease progression stage (Daniels, 2005; WHO, 2008c). The second condition is that an individual has reached stage 3 of HIV, possesses a CD4 cell count of 350 or below, and has experienced any of the AIDS definitive illnesses, such as Kaposi’s sarcoma, wasting syndrome, pulmonary tuberculosis, pneumonitis, lymphoma of the brain, recurrent invasive bacterial infections, persistent mucosal candidiasis, chronic diarrhea, or prolonged fever of unknown etiology (Daniels, 2005; Laing & Hodgkin, 2006; WHO, 2004). The third condition is that the individual has reached stage 4 of the disease or has been diagnosed with AIDS, irrespective of CD4 cell count or manifestation of any serious opportunistic illness (WHO, 2008c).
U.S. centers, on the contrary, follow the Department of Health and Human Services guidelines for initiation of anti-HIV drug treatment. These guidelines recommend that all HIV-positive expecting mothers and anyone with symptomatic HIV illnesses in the United States should initiate HAART regardless of CD4 cell count (Hammer et al., 2006; Sterling, Chaisson, Keruly, & Moore, 2003; Yeni et al., 2005). However, DHHS only recommends HAART initiation for asymptomatic