The Survival Benefits of Antiretroviral Therapy in South Africa

Abstract

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.

The History of the HIV/AIDS Epidemic in Africa

“…The nevirapine results (HIVNET 012) set the stage for more innovative and more efficacious preventive strategies which extended the use of nevirapine during lactation for up to 14 weeks [45][46][47] as well as trials to reduce emergency of resistance to nevirapine through addition of such drugs as zidovudine and lamivudine to nevirapine [48]. [50][51][52][53][54][55] with reductions in deaths due to AIDS-defining comorbidities [53]. ART did not only serve a treatment role but also provide additional tools for HIV prevention.…”

The Impact of the 2013 WHO Antiretroviral Therapy Guidelines on the Feasibility of HIV Population Prevention Trials

“…We fi rst used the Cost-Effectiveness of Preventing AIDS Complications International (CEPAC-I) model, 5,19,20 a patient-level microsimulation, to project survival, CD4 count, and HIV RNA trajectories of infected individuals. These trajectories then served as input to the HIV Dynamic Epidemic Framework (H-DEF) transmission model, 21 a dynamic, open-cohort epidemic simulation.…”

“…5,19,20 The model generates a cohort of HIV-infected individuals by drawing The transmission rate multiplier is used to increase transmission rates observed among heterosexual serodiscordant couples to rates refl ective of the general population. For sensitivity analysis, test offer and consent are combined into a single probability with base case value of 72%.…”

“…[1][2][3][4][5] In 2011, the HPTN 052 trial demonstrated that effective treatment could also dramatically reduce the risk of HIV transmission in stable serodiscordant sexual partnerships. 6 Although the individual preventive impact of ART is clear, questions remain regarding the populationlevel effect of treatment-as-prevention in different settings.…”

HIV-Tat induces a decrease in I Kr and I Ks via reduction in phosphatidylinositol-(4,5)-bisphosphate availability

“…For this population, excess mortality is moderate in industrialized countries and comparable with populations having other chronic conditions [1]. Life expectancy of HIV-positive individuals has also increased in middle income countries, gaining for instance 10 years between 2004 and 2011 in South Africa [2].…”