Economic and quality of life outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review

Abstract

The impacts of antiretroviral therapy (ART) on quality of life, mental health, labor productivity, and economic wellbeing for people living with HIV/AIDS in developing countries are only beginning to be measured. We conducted a systematic literature review to analyze the effect of ART on these economic and quality of life indicators in developing countries and assess the state of research on these topics. We searched Ovid/Medline, PubMed, Psych Info, Web of Science, Google Scholar, and the abstract database of the International AIDS Society Conference and the Conference on Retroviruses and Opportunistic Infections. Both qualitative and quantitative studies were included, as were peer-reviewed articles, gray literature, and conference abstracts and presentations. Findings are reported from 21 publications, including 14 full-length articles, six abstracts, and one presentation (representing 16 studies). Compared to HIV-positive patients not yet on treatment, patients on ART reported significant improvements in physical, emotional and mental health, and daily function. Work performance improved and absenteeism decreased, with the most dramatic changes occurring in the first three months of treatment and then leveling off. Little research has been done on the impact of ART on household wellbeing, with modest changes in child and family wellbeing within households where adults are receiving ART reportrd so far. Most studies from developing countries have not yet assessed economic and quality of life outcomes of therapy beyond the first year; therefore, longitudinal outcomes are still unknown. Findings were limited geographically, with an emphasis on sub-Saharan Africa and adult treatment. As ART roll out extends throughout high HIV prevalence, low-resource countries and is sustained over years and decades, research on pediatric and differential gender economic and quality of life outcomes will become increasingly urgent, as will systematic evaluation of ART programs.

Health-Related Quality of Life and Antiretroviral Therapy in Kwazulu-Natal, South Africa

“…As with some other researchers, I found that HIV symptoms (Préau et al, 2004), depression scores on a rating scale (Beard et al, 2009;Jelsma et al, 2005;Judd et al, 2000;Stangl et al, 2007), and internalized stigma reduced over time, whereas CD4 cell counts (Bhargava & Booysen, 2010;Langius-Eklöf et al, 2009), adherence to ART (Maqutu, Zewotir, North, Naidoo, & Grobler, 2010), and social support increased over 20 months (Burgoyne & Renwick, 2004). Social support has been shown to positively influence quality of life outcomes by mediating depression (Jia et al, 2005;Stangl et al, 2007).…”

“…These findings were supported in more recent studies conducted in South Africa (Bhargava & Booysen, 2010) and in other Southern African countries (Greeff et al, 2010). Beard et al (2009) further observed that most researchers in developing countries have not yet assessed economic and quality-of-life outcomes of therapy beyond the first year; therefore, longitudinal outcomes are still unknown. In studies with longitudinal outcomes conducted in high-income countries over a period of 2 years or more it has been found that there was significant clinical improvement and that HRQoL was either reduced, sustained, or improved (Burgoyne, Rourke, Behrens, & Salit, 2004;Eriksson et al, 2005;Judd et al, 2000;Langius-Eklöf, Lidman, & Wredling, 2009;Préau et al, 2004).…”

“…Beard, Feeley, and Rosen (2009) conducted a systematic literature review to analyze the effect ART has on economic and quality-of-life indicators of people in developing countries, and then assessed the state of research on these topics. Results showed that, compared to HIV-positive patients not yet receiving treatment, patients receiving ART reported significant improvements in physical, emotional, and mental health, as well as in daily function.…”

Economic modeling of HIV treatments

“…A systematic review of economic and quality-of-life outcomes of ARV therapy for HIV/AIDS in developing countries [25] did not include any modeling studies. However, a recent trend in health economics literature towards use of short-term treatment comparisons using a cost-effectiveness frontier (CEF) [26][27][28] is reflected in Economic modeling of HIV treatments Simpson 243 several ARV studies.…”

Nanoparticle-based drug delivery to improve the efficacy of antiretroviral therapy in the central nervous system

“…The introduction of combination antiretroviral therapy (cART) around 1996 had a huge impact on the management of acquired immunodeficiency syndrome (AIDS), and resulted in increased quality of life and lifespan of seropositive individuals. 2,3 However, several limitations of currently available drugs, namely their toxicity and poor pharmacokinetics, the need to be used for prolonged periods of time (if not chronically), and the emergence of viral resistance, still jeopardize the optimal efficacy of cART. 4 Of particular importance is the poor bioavailability of several anti-HIV drugs at viral reservoir sites, such as the central nervous system (CNS), in special brain macrophages and microglia cells, when using available dosage forms.…”