Initiation of antiretroviral therapy based on the 2015 WHO guidelines. (28th November 2016)

• Record Type: Journal Article
• Authors: Kuznik, Andreas; Iliyasu, Garba; Habib, Abdulrazaq G.; Musa, Baba M.; Kambugu, Andrew; Lamorde, Mohammed
• Is Part Of: AIDS. Volume 30:Number 18(2016)
• Publication Date: 2016-11-28
• Subjects: antiretroviral therapy -- cost-effectiveness analysis -- cost-utility analysis -- HIV; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000001251
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: In 2015, the WHO recommended initiation of antiretroviral therapy (ART) in all HIV-positive patients regardless of CD4 + cell count. We evaluated the cost-effectiveness of immediate versus deferred ART initiation among patients with CD4 + cell counts exceeding 500cells/μl in four resource-limited countries (South Africa, Nigeria, Uganda, and India). Design: A 5-year Markov model with annual cycles, including patients at CD4 + cell counts more than 500 cells/μl initiating ART or deferring therapy until historic ART initiation criteria of CD4 + cell counts more than 350 cells/μl were met. Methods: The incidence of opportunistic infections, malignancies, cardiovascular disease, unscheduled hospitalizations, and death, were informed by the START trial results. Risk of HIV transmission was obtained from a systematic review. Disability weights were based on published literature. Cost inputs were inflated to 2014 US dollars and based on local sources. Results were expressed in cost per disability-adjusted life years averted and measured against WHO cost-effectiveness thresholds. Results: Immediate initiation of ART is associated with a cost per disability-adjusted life years averted of −$317 [95% confidence interval (CI): −$796–$817] in South Africa; −$507 (95% CI: −$765–$837) in Nigeria; −$136 (−$382–$459) in Uganda; and −$78 (−$256–$374) in India. The results are largely driven by the impact of ART on reducing the risk of new HIV transmissions. Conclusions: In HIV-positive patients with CD4 + counts above 500 cells/μl in the four studied countries, immediate initiation of ART versus deferred therapy until historic eligibility criteria are met is cost-effective and likely even cost-saving over time. Abstract : Supplemental Digital Content is available in the text