HIV: early treatment is key

The report said even just sustaining current HIV treatment and prevention efforts would require at least a third of total government health spending in the most affected African countries from 2014 to 2030.

The report said even just sustaining current HIV treatment and prevention efforts would require at least a third of total government health spending in the most affected African countries from 2014 to 2030.

Published Apr 10, 2013

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Durban - People living with HIV in South Africa who start antiretroviral therapy before their immune systems are severely compromised have life expectancies close to that of the general population, researchers have found.

Published this week in the journal PLOS Medicine, the research shows that the life expectancy is around 80 percent of that of the general population, provided those with HIV initiate treatment before their CD4 count (a measure of the strength of the immune system at the time of starting treatment) drops below 200.

The findings could affect the cost of life insurance (reducing it) and epidemiological modelling estimates, which typically assume that life expectancy after starting antiretroviral therapy is around 10 years.

Lead researcher Leigh Johnson, of the University of Cape Town, and colleagues collected information from six HIV treatment programmes in South Africa between 2001 and 2010.

The survival model shows that the most significant factor determining the life expectancy of patients starting HIV treatment is their age when they started treatment.

The average life expectancy (additional years of life) of men starting antiretroviral therapy varied between 27.6 years at age 20 and 10.1 years at 60. Corresponding estimates in women were 36.6 at 20 and 14.4 years at 60.

The UCT researchers also found that life expectancy was significantly influenced by baseline CD4 counts. Life expectancy in patients with baseline CD4 counts of 200 cells per microlitre or more was between 70 percent and 86 percent of those HIV-negative adults of the same age and sex, while patients starting treatment with CD4 counts of less than 50 had life expectancies that were between 48 percent and 61 percent of those of HIV-negative adults. The study showed that risk of death was the highest during the first year after starting antiretroviral therapy, because of the delay between the start of treatment and the recovery of the immune system.

Johnson says the study showed that many HIV patients were still starting treatment at very low CD4 counts. Health services must overcome major challenges, such as late diagnosis, low uptake of CD4 testing, loss from care, and delayed antiretroviral therapy initiation, if near-normal life expectancies were to be achieved for the majority of people with HIV in South Africa.

 

The researchers said their finding made it imperative to find funding systems and innovative ways to reduce the costs of antiretroviral therapy. – Health-e News Service

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