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Modeling the Survival Benefits of HIV Treatment in the U.S.
HIV treatments saved about 3 million years of life from 1989 through 2003 — or about 13 years per treated person.
The past 15 years have brought major advances in HIV treatment in the U.S. How many years of life have been saved as result? To answer this question, a research group used its widely published model of HIV/AIDS natural history (N Engl J Med 2001; 344:824) incorporating nationally representative surveillance data, as well as efficacy data on different treatment regimens during six treatment eras from 1989 through 2003. The eras were defined according to when major interventions became the standard of HIV care; two additional eras of prevention of mother-to-child transmission (MTCT) were also included. The modelers assumed that "patients received the recommended standards of care in the year of their diagnosis."
Using length of survival before the advent of antiretroviral therapy as the referent, the researchers estimated that treatment saved 2.8 million years of life cumulatively from 1989 through 2003 — about 13 years of life per treated person. With MTCT prevention included, the estimated benefit approached 3 million years of life saved.
Comment: The large estimated increase in benefits from era to era is very promising. An accompanying editorial calls for celebration but also highlights challenges for the future: It calls for expedited development of antiretroviral drugs to achieve public health goals and notes that better screening programs would increase the benefits of treatment.
The authors make a strong case for rapidly scaling up treatment programs. However, their estimates depend on a country’s ability to deliver the recommended standard of care. In developing countries, there might be fewer years of life saved if the full spectrum of second-line and rescue therapies is not available, the typical HIV-infected person starts therapy at a more advanced stage of disease, or the health system is less able to ensure appropriate prescription of and high-level adherence to treatment.
Nonetheless, these new estimates of increased life expectancy with antiretroviral therapy are the best available to date and represent a substantial increase over the authors’ previous estimates. Increasing life expectancy on antiretroviral therapy implies higher lifetime treatment costs. Although the authors explicitly call for increasing coverage of therapy, their results highlight the need for redoubling global prevention efforts. In previous models using more conservative survival assumptions, prevention yielded cost savings (ACC Apr 12 2006); these new results imply that savings are increasing over time and that prevention should receive even greater priority.
— Stefano M. Bertozzi, MD, PhD, and Sergio Bautista-Arredondo, MSc
Dr. Bertozzi is the Director of Health Economics and Evaluation at the National Institute of Public Health in Cuernavaca, Mexico. Mr. Bautista-Arredondo is an Investigator in the Health Economics and Evaluation unit at the National Institute of Public Health.
Published in AIDS Clinical Care July 11, 2006
Citation(s):
Walensky RP et al. The survival benefits of AIDS treatment in the United States. J Infect Dis 2006 Jul 1; 194:11-9.
- Medline abstract (Free)
Vermund SH. Millions of life-years saved with potent antiretroviral drugs in the United States: A celebration, with challenges. J Infect Dis 2006 Jul 1; 194:1-5.
- Medline abstract (Free)