Benefits of Antiretroviral Therapy in Africa

Journal of Infectious Diseases
Volume 209 Issue 4 February 15, 2014
http://jid.oxfordjournals.org/content/current

EDITORIAL COMMENTARIES
Massive Benefits of Antiretroviral Therapy in Africa
Sten H. Vermund1,2
http://jid.oxfordjournals.org/content/209/4/483.extract
Extract
One of the most positive, life-affirming, and transformational public health efforts in modern history is the US President’s Emergency Plan for AIDS Relief (PEPFAR) [1–4]. This bilateral program (which involves the United States and individual partner nations) has had an unprecedented $44.3 billion appropriated from the US Congress from fiscal year 2004 through fiscal year 2012 (as of 31 March 2013), including over $7 billion to its multilateral partner, the Global Fund to Fight AIDS, Tuberculosis and Malaria [5]. Additional funds have been provided by other donor nations, typically through the Global Fund, and by national governments of low- and middle-income countries. These resources have gone toward the global effort to prevent human immunodeficiency virus (HIV) infection and to offer lifesaving antiretroviral therapy (ART)-based care to HIV-infected persons [6]. With its many partners, PEPFAR has directly supported >6 million persons, most in sub-Saharan Africa, among the >10 million persons estimated to have begun ART as of 2013. Since South African legal rulings and the change in government in 2009, the Government of South Africa has been an enthusiastic partner—with its people and with the global community—making up for lost time in the effort to address the epidemic and cooperate with its neighbors in southern Africa [7–9]. No nation has a higher number of infected persons than South Africa, and the southern African nations have the highest prevalence of HIV infection in the world, ranging to over half of the adult population in certain venues and age groups [10]. The Government of South Africa, with support from PEPFAR and the Global Fund, has supported the Herculean efforts of health workers, activists, and patients to reverse the …

Editor’s choice: The Survival Benefits of Antiretroviral Therapy in South Africa
Michael D. April, Robin Wood, Bethany K. Berkowitz, A. David Paltiel, Xavier Anglaret, Elena Losina, Kenneth A. Freedberg, and Rochelle P. Walensky
J Infect Dis. (2014) 209 (4): 491-499 doi:10.1093/infdis/jit584
Abstract
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Supplementary Data
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.