Early Antiretroviral Therapy Reduces HIV-Related Sequelae



The HPTN 052 study is ongoing. All HIV infected subjects were offered ART and 93% of the index cases are now on it. Retention is 96% among the index cases and 85% for the discordant couples. Still undetermined are the durability of the prevention benefit and the consequences of delayed ART on clinical outcomes over a longer follow-up, she said.

In addition, giving antiretroviral therapy early to HIV-positive patients is cost effective over a 5-year and lifetime horizon, according to a subanalysis of HPTN 052.

Researchers from the Harvard Medical School, Boston, presented the cost-effectiveness analysis on behalf of the HPTN. They analyzed 5-year and lifetime survival and costs in India and South Africa.

To be deemed "very cost effective," early ART had to be less than one times the per capita gross domestic product of each country. To be "cost effective," it would need to be less than three times the gross domestic product (GDP). In South Africa, the per capita GDP was $8,100, and in India it was $1,400.

The cost of ART – whether early or delayed – was higher in South Africa than in India, largely because the costs of care were higher. Early ART for the initially infected patients cost $4,600 over the 5-year horizon in South Africa and $2,300 in India. The lifetime cost for early ART was $18,400 in South Africa, compared with $11,300 in India.

Early ART cost more than delayed ART. But survival was higher with early ART – 93%, compared with 84% for delayed ART in South Africa, for instance – and there was a marked and immediate decrease in transmission for early ART in both India and South Africa, said Dr. Kenneth A. Freedberg, director of the HIV Research Program in the division of general medicine at Massachusetts General Hospital, Boston.

The early therapy also prevented opportunistic infections in South Africa. It was deemed very cost effective in South Africa, at $700/year of life saved in the 5-year time frame, and $1,200/year of life saved over the lifetime.

In India, early ART increased survival also and reduced transmissions of the virus. It was deemed cost effective in that country, at $2,900/year of life saved over the 5-year time frame. The lifetime horizon nudged it up to very cost effective at $1,300/year of life saved.

Increased survival in both countries was a bit of a double-edged sword. Those who lived longer also tended to have more HIV transmissions, Dr. Freedberg explained. Even so, early ART appears to be a winning strategy, he said.

"The clinical data, the behavioral data, the economic data, are converging on the very clear consensus that early antiretroviral therapy is clinically effective for individuals, prevents transmission, and is very cost effective," he said in presenting the abstract.

Dr. Freedberg added that early ART should definitely be given to serodiscordant couples.

In addition, he said, "We’re moving toward the situation where the data support early antiretroviral therapy for anybody infected."

The HIV Prevention Trials Network is funded by the National Institute of Allergy and Infectious Diseases. Study drugs were donated by Abbott Laboratories, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Gilead Sciences; GlaxoSmithKline/ViiV Healthcare, and Merck.

Dr. Grinsztejn stated that she has no additional disclosures.

Alicia Ault, a medical media reporter for IMNG, contributed to this article.

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