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THE SURVIVAL BENEFITS OF ANTIRETROVIRAL THERAPY IN SOUTH AFRICA

Tuesday, 28th of January 2014

THE SURVIVAL BENEFITS OF ANTIRETROVIRAL THERAPY IN SOUTH AFRICA

 

J Infect Dis. (2014) 209 (4): 491-499. doi: 10.1093/infdis/jit584 First published online: December 3, 2013

Michael D. April1,2,5,

Robin Wood13,14,

Bethany K. Berkowitz5,

A. David Paltiel12,

Xavier Anglaret15,16,17,

Elena Losina2,3,8,10,

Kenneth A. Freedberg2,3,4,5,6,7,9 and

Rochelle P. Walensky2,3,5,6,7,11

+ Author Affiliations

1Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Texas

2Harvard Medical School

3Center for AIDS Research

4Department of Health Policy and Management, Harvard School of Public Health, Harvard University

5The Medical Practice Evaluation Center

6Division of Infectious Diseases

7Division of General Medicine, Massachusetts General Hospital

8Department of Biostatistics

9Department of Epidemiology, Boston University

10Department of Orthopedic Surgery

11Division of Infectious Diseases, Brigham and Womens Hospital, Boston, Massachusetts

12Yale School of Public Health, New Haven, Connecticut

13Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine

14Department of Medicine, University of Cape Town, Cape Town, South Africa

15INSERM, Centre 897

16Université Bordeaux Segalen, Bordeaux, France

17Programme PAC-CI/ANRS Research Site in Abidjan, Côte dIvoire

Correspondence: Michael D. April, MD, DPhil, MSc, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, 9th Fl, Boston, MA 02114 (michael.d.april@post.harvard.edu).

Presented in part: 20th Conference on Retroviruses and Opportunistic Infections, Atlanta, Georgia, 3 March 2013 (poster Y-144); 66th Annual Meeting of the MGH Scientific Advisory Committee, Boston, Massachusetts 19 March 2013; 2nd Annual San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas 25 April 2013.

Abstract below; full text is at http://jid.oxfordjournals.org/content/209/4/491.full

Background. We sought to quantify the survival benefits attributable to antiretroviral therapy (ART) in South Africa since 2004.

Methods. We used the Cost-Effectiveness of Preventing AIDS Complications–International model (CEPAC) to simulate 8 cohorts of human immunodeficiency virus (HIV)–infected patients initiating ART each year during 2004–2011. Model inputs included cohort-specific mean CD4+ T-cell count at ART initiation (112–178 cells/µL), 24-week ART suppressive efficacy (78%), second-line ART availability (2.4% of ART recipients), and cohort-specific 36-month retention rate (55%–71%). CEPAC simulated survival twice for each cohort, once with and once without ART. The sum of the products of per capita survival differences and the total numbers of persons initiating ART for each cohort yielded the total survival benefits.

Results. Lifetime per capita survival benefits ranged from 9.3 to 10.2 life-years across the 8 cohorts. Total estimated population lifetime survival benefit for all persons starting ART during 2004–2011 was 21.7 million life-years, of which 2.8 million life-years (12.7%) had been realized by December 2012. By 2030, benefits reached 17.9 million life-years under current policies, 21.7 million life-years with universal second-line ART, 23.3 million life-years with increased linkage to care of eligible untreated patients, and 28.0 million life-years with both linkage to care and universal second-line ART.

Conclusions. We found dramatic past and potential future survival benefits attributable to ART, justifying international support of ART rollout in South Africa.