Treating HIV Sooner Would Save South African Lives and Money

Via Science Daily.

If the South African government followed a recent recommendation by the World Health Organization to start antiretroviral therapy (ART) for HIV-infected residents earlier in the progress of the disease, the policy shift would start saving the country money after 16 years and would extend thousands of lives for dozens of years, according to a new study.

In 2009, the WHO recommended that people start ART when a key measure of immune system strength, the CD4+ cell counts, reaches a concentration of 350 per microliter of blood. South Africa has instead decided to stick with the old standard of waiting until only 200 cells per microliter remain, reflecting a more compromised immune system.

"South Africa, the country with the most people living with HIV/AIDS in the world, has not yet adopted the WHO treatment initiation criteria," said Mark Lurie, a Brown University epidemiology professor and senior author of the study published online July 20 in PLoS One. "We used a mathematical model to predict the impact of adopting the new WHO guidelines on HIV prevalence, incidence, and cost. We found that changing the treatment guidelines would have a profound impact on HIV incidence. It would require, over five years, an additional 7 percent investment, resulting in 28 percent more patients receiving HIV treatment. After 16 years, the cumulative net costs reach a break even point."

In addition, the models developed by Lurie's team show South Africa saving more than 120,000 life-years by 2040. Life-years are determined by multiplying the number of people who will still be alive by the number of years of extra longevity.

The reason why the higher up-front investment in ART ultimately would save South Africa money and lives, the authors wrote, is because more aggressive ART treatment would curb the epidemic's spread. Reduced infectivity from the drugs would outweigh the longer period of time in which HIV-infected people would be alive and therefore able to spread the virus.

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