Early HIV antiviral treatment found to be cost-effective in South Africa, India

October 30, 2013, Massachusetts General Hospital

early initiation of antiretroviral therapy (ART) for HIV-infected individuals with uninfected sexual partners to prevent viral transmission – appears to make economic sense, along with meeting its clinical goals of helping infected patients stay healthy and reducing transmission. A model-based analysis of data from an important clinical trial projected that early ART for such patients in both South Africa and India would be very cost-effective over the lifetime of patients. In fact, early ART in South Africa would actually save money during the first five years. The report appears in the October 31 New England Journal of Medicine.

"By demonstrating that early HIV therapy not only has long-term clinical benefits to individuals but also provides excellent economic value in both low- and middle-income countries, this study provides a critical answer to an urgent policy question," says Rochelle Walensky, MD, MPH, of the Massachusetts General Hospital (MGH) Division of Infectious Disease, corresponding author of the NEJM report. "In short, early ART is a 'triple winner': HIV-infected live healthier lives, their partners are protected from HIV, and the investment is superb."

In 2011 the HIV Prevention Trials Network – an international research collaborative – published results of a trial showing that treatment as prevention dramatically reduced the risks of and also substantially cut the time to AIDS-related events and infections like tuberculosis in the HIV-infected patients. Called HPTN 052 and conducted at sites in nine countries, that trial was led by Myron Cohen, MD, of the University of North Carolina at Chapel Hill, and subsequently was named the 2011 Breakthrough of the Year by the journal Science. In the current National Institute of Allergy and Infectious Disease (NIAID)-supported study, the researchers worked in collaboration with the HPTN 052 trial team to analyze the trial data – focusing on sites in India and South Africa, countries with the world's highest rates of HIV infection – to determine whether those clinical benefits were worth the costs of ART on both short- and long-term bases.

HPTN 052 participants in the early-ART group started treatment at CD4 T cells – a measure of immune system function – between 350 and 550, while the control group did not start therapy until their CD4 cells dropped below 250, which was in line with World Health Organization treatment guidelines at the time. In their current analysis, the researchers used a mathematical model simulating HIV treatment and transmission and its associated health and economic outcomes to make projections for two years (the time period covered by HPTN 052), five years, and the expected lifetime of the infected participants.

The results indicated that, during the first five years, 93 percent of patients receiving early ART would survive, compared with 83 percent of those whose treatment was delayed. Life expectancy for the early-treatment group was almost 16 years, compared with nearly 14 years for the delayed treatment group. During the first five years, the potential costs of infections that were prevented by early in South Africa – particularly tuberculosis – would outweigh the costs of ART medications, indicating that the strategy actually would save overall costs. While this was not the case for India, where of care for opportunistic infections are less, early ART in that country was projected to be cost-effective, according to established standards. Across patient lifetimes, early ART was determined to be very cost effective in both countries. Most of the clinical benefits were seen in the infected patients – fewer illnesses and deaths – and there were also added clinical and economic benefits from reducing HIV transmission.

"The reason early ART doesn't save money in the long term is actually due to its success," explains Walensky, who is a professor of Medicine at Harvard Medical School. "Patients will live much longer and take these effective medications for many years. Now that we know that early ART not only improves clinical and prevention outcomes but also is a great investment, we need to redouble international efforts to provide ART to any HIV-infected person who can benefit from it."

"Some people have questioned whether providing early ART to all who need it would be feasible in resource-limited countries," adds Kenneth Freedberg, MD, MSc, director of the MGH Medical Practice Evaluation Center and professor of Medicine at Harvard Medical School. "We've shown that in countries like South Africa, where it actually saves money in the short-term, the answer is 'yes.' We believe that continued international public and private partnerships can make this true in other as well. With this kind of investment, we foresee dramatic decreases in infections and illness that could save millions of lives over the next decade."

Explore further: Expanded analysis of HPTN 052 study results show cost-effectiveness of early treatment of HIV

Related Stories

Expanded analysis of HPTN 052 study results show cost-effectiveness of early treatment of HIV

July 27, 2012
When the HIV Prevention Trials Network (HPTN) 052 investigators released their landmark study results last year showing that treatment can reduce HIV transmission by 96% in serodiscordant couples, questions were raised about ...

New HPTN 052 study results reveal additional benefits of early HIV treatment

July 26, 2012
Study results released today by the HIV Prevention Trials Network (HPTN) show additional benefits of early antiretroviral therapy (ART) in HIV clinical outcomes. Expanded analysis of HPTN 052 study data, presented today at ...

HIV elimination in South Africa could be achieved by current treatment policy

October 22, 2013
The current antiretroviral treatment policy in South Africa could lead to elimination of HIV within the country over the next 24 to 34 years, but a universal test and treat (UTT) approach could achieve elimination 10 years ...

Landmark HIV treatment-as-prevention study shows additional health benefits, cost-effectiveness

July 27, 2012
WHAT: Further analyses of the landmark NIH-funded treatment-as-prevention study (HPTN 052) have found that providing antiretroviral treatment to HIV-infected individuals earlier, when their immune systems are healthier, delays ...

Study evaluates population-wide testing, early treatment for HIV prevention

September 30, 2013
A study in South Africa and Zambia will assess whether house-to-house voluntary HIV testing and prompt treatment of HIV infection, along with other proven HIV prevention measures, can substantially reduce the number of new ...

Older children with HIV may need to start treatment sooner to normalize future CD4 count

October 29, 2013
Although younger children with HIV are at high risk of disease progression if not treated, new research published this week in PLOS Medicine indicates that they have good potential for achieving high CD4 counts (a measure ...

Recommended for you

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

Researchers find clues to AIDS resistance in sooty mangabey genome

January 3, 2018
Peaceful co-existence, rather than war: that's how sooty mangabeys, a monkey species found in West Africa, handle infection by SIV, a relative of HIV, and avoid developing AIDS-like disease.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.