More than a year ago, a landmark study found that putting patients infected with HIV on drug treatment early would prevent them from transmitting the disease to others. The study was deemed the scientific breakthrough of 2011 by Science magazine and formed a cornerstone of a new U.S. strategy to curb the pandemic globally.
Now, new results from the ongoing study suggest early treatment is cost-effective and helps prevent infection with AIDS-related illnesses such as tuberculosis, certain bacterial infections or herpes.
The findings, released at the XIX International AIDS Conference in Washington this week, add to a growing body of evidence that people infected with HIV should be offered treatment earlier than some current guidelines recommend, AIDS scientists say.
The World Health Organization recommends that all patients with a CD4 count of 350 be put on lifesaving antiretroviral drugs but also says any HIV-infected person with an uninfected partner should be offered treatment in order to prevent them from transmitting the disease to their partner. A CD4 count is a measure of a type of white blood cell that fights infection; the higher the count, the less the person has been affected by the HIV virus.
U.S. guidelines recommend that any patient diagnosed with HIV be offered treatment.
There are cost implications to putting every HIV-infected individual on drug treatment. Globally donors spent $16.8 billion fighting AIDS in 2011, but that includes supporting only about eight million people on treatment, while 34.2 million are infected with HIV, according to the Joint United Nations Program on HIV/AIDS, or UNAIDS.
While the two studies didn't examine patients with CD4 counts higher than 550, it points to the benefits of immediate treatment for anyone infected with HIV, said Myron Cohen, vice chancellor for global health at the University of North Carolina at Chapel Hill, who leads the so-called treatment-as-prevention study.
"Now we have unequivocal scientific evidence of personal benefit, benefit to loved ones, and we think community benefit of immediate treatment," he said. "Treating 34 million people is the right thing to do."
In the study of cost effectiveness, researchers compared patients from the study in two geographically and economically diverse countries—South Africa and India—over a five-year period and longer term. One group of patients had started on antiretroviral therapy early, at CD4 counts between 350 and 550, while the patients in the other group didn't go on treatment until their CD4 count had sunk below 250.
The researchers found that over the long term, starting treatment in the earlier group was cost effective in both countries, meaning that the amount spent to save one year of life was less than one time gross domestic product per capita. GDP per capita is $8,100 in South Africa and $1,400 in India, according to the analysis.
Over a five-year period, starting treatment early was cost-effective in India, meaning that the amount spent to save one year of life was less than three times GDP per capita, the researchers found.
And while cost savings are rare in health, that is what the researchers found from early treatment over a five-year period in South Africa.
"Early ART is a triple winner," said Rochelle Walensky of the Harvard Center for AIDS Research, who led the work. "HIV-infected patients do better, their partners are protected and it is very cost-effective."
The second piece of research showed that the patient group that started earlier had fewer cases of tuberculosis and other AIDS-related illnesses. Those illnesses that did occur didn't develop as quickly as in the delayed group.
No differences were noted between the two groups in diseases that aren't related to AIDS, Dr. Cohen said.
"These data call for decisive action by the U.S. global AIDS program, WHO and by national governments," said Asia Russell of the advocacy organization Health GAP. "National eligibility guidelines should change to support earlier initiation, and national programs should act faster to accelerate coverage to save lives and reduce new infections.
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