ART Could Save 18 Million Life-Years in South Africa by 2030

Steven Fox

December 04, 2013

Antiretroviral therapy (ART) has been enormously effective at combating HIV in South Africa, with nearly 3 million life-years saved by the end of 2011, according to results from a new study. These already substantial benefits could grow exponentially with more HIV testing and treatment, reaching 18 million life-years by 2030.

South Africa's HIV epidemic is the most widespread in the world, with an estimated 5.6 million people infected as of 2011, note Michael D. April, MD, from the Medical Practice Evaluation Center at Massachusetts General Hospital in Boston, and colleagues in an article published online December 3 in the Journal of Infectious Diseases.

Despite significant international commitments to make ART more widely available in South Africa, about a third of individuals there who are eligible for such treatment go without.

"Meanwhile, current economic challenges have prompted resource-allocation debates that might jeopardize the ongoing treatment of individuals who are already receiving ART and the linkage to care of untreated patients who are eligible for treatment," the authors write.

Looking to highlight the value of ART in South Africa, these researchers used a computer simulation (The Cost-Effectiveness of Preventing AIDS Complications–International Model of HIV Disease and Treatment [CEPAC]) to quantify the cumulative survival benefits of ART since it was first introduced in South Africa nearly a decade ago. Tailoring those simulations, they also projected the additional benefits that could be expected by expanding HIV testing and ART.

Previous studies have provided indirect evidence of the survival benefits associated with ART, the researchers note. "However, to our knowledge, no prior studies have quantified the direct impact of ART rollout on population survival," they write.

Using the CEPAC model, they simulated 8 cohorts of HIV-infected patients beginning ART therapy during each of the years from 2004 through 2011.

The researchers factored several variables into the simulation, including cohort-specific mean CD4 T-cell counts at the time ART was initiated, the suppressive efficacy of therapy after 24 weeks of ART, the availability of second-line ART, and 36-month retention rates for each cohort.

They also used their model to simulate survival on the basis of 2 different scenarios: management of patients with the benefit of ART and management of those without this benefit. To come up with total survival benefits, the researchers combined the products of per capita survival benefits along with the initial size of each treated cohort.

According to their calculations, they report that as of the end of 2011, ART has been associated with 2.8 million life-years saved. However, that is only a small fraction of the benefits that could be expected with continued commitment to ART, according to the researchers' projections.

"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," they write.

"This study contributes to a growing literature establishing the profound survival benefits resulting from investments in the global response to the HIV pandemic," the researchers write.

However, they stress that continued dedication to treating HIV is crucial for success. "Realization of these future potential benefits will require not only drugs but also commitment by the international community to continue implementing and refining effective treatment programs and practices."

This work was supported by the National Institute of Allergy and Infectious Diseases and the Infectious Diseases Society of America (Medical Scholars Program). The authors have disclosed no relevant financial relationships.

J Infect Dis. Published online December 3, 2013. Full text

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