Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa
BACKGROUND: Despite growing international pressure to provide HIV-1 treatment to less-developed countries, potential demographic and epidemiological impacts have yet to be characterised. We modelled the future impact of antiretroviral use in South Africa from 2000 to 2005.
METHODS: We produced a population projection model that assumed zero antiretroviral use to estimate the future demographic impacts of the HIV-1 epidemic. We also constructed four antiretroviral-adjusted scenarios to estimate the potential effect of antiretroviral use. We modelled total drug cost, cost per life-year gained, and the proportion of per-person health-care expenditure required to finance antiretroviral treatment in each scenario.
FINDINGS: With no antiretroviral use between 2000 and 2005, there will be about 276,000 cumulative HIV-1-positive births, 2,302,000 cumulative new AIDS cases, and the life expectancy at birth will be 46.6 years by 2005. By contrast, 110,000 HIV-1-positive births could be prevented by short-course antiretroviral prophylaxis, as well as a decline of up to 1 year of life expectancy. The direct drug costs of universal coverage for this intervention would be US$54 million--less than 0.001% of the per-person health-care expenditure. In comparison, triple-combination treatment for 25% of the HIV-1-positive population could prevent a 3.1-year decline in life expectancy and more than 430,000 incident AIDS cases. The drug costs of this intervention would, however, be more than $19 billion at present prices, and would require 12.5% of the country's per-person health-care expenditure.
INTERPRETATION: Although there are barriers to widespread HIV-1 treatment, limited use of antiretrovirals could have an immediate and substantial impact on South Africa's AIDS epidemic.
| Errataetall: |
CommentIn: Lancet. 2000 Aug 12;356(9229):600. - PMID 10950269 |
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| Medienart: |
Artikel |
| Erscheinungsjahr: |
2000 |
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| Erschienen: |
2000 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:355 |
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| Enthalten in: |
Lancet (London, England) - 355(2000), 9221 vom: 17. Juni, Seite 2095-100 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wood, E [VerfasserIn] |
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| Anmerkungen: |
Date Completed 03.08.2000 Date Revised 16.06.2015 published: Print CommentIn: Lancet. 2000 Aug 12;356(9229):600. - PMID 10950269 Citation Status MEDLINE |
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| 100 | 1 | |a Wood, E |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa |
| 264 | 1 | |c 2000 | |
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| 500 | |a CommentIn: Lancet. 2000 Aug 12;356(9229):600. - PMID 10950269 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Despite growing international pressure to provide HIV-1 treatment to less-developed countries, potential demographic and epidemiological impacts have yet to be characterised. We modelled the future impact of antiretroviral use in South Africa from 2000 to 2005 | ||
| 520 | |a METHODS: We produced a population projection model that assumed zero antiretroviral use to estimate the future demographic impacts of the HIV-1 epidemic. We also constructed four antiretroviral-adjusted scenarios to estimate the potential effect of antiretroviral use. We modelled total drug cost, cost per life-year gained, and the proportion of per-person health-care expenditure required to finance antiretroviral treatment in each scenario | ||
| 520 | |a FINDINGS: With no antiretroviral use between 2000 and 2005, there will be about 276,000 cumulative HIV-1-positive births, 2,302,000 cumulative new AIDS cases, and the life expectancy at birth will be 46.6 years by 2005. By contrast, 110,000 HIV-1-positive births could be prevented by short-course antiretroviral prophylaxis, as well as a decline of up to 1 year of life expectancy. The direct drug costs of universal coverage for this intervention would be US$54 million--less than 0.001% of the per-person health-care expenditure. In comparison, triple-combination treatment for 25% of the HIV-1-positive population could prevent a 3.1-year decline in life expectancy and more than 430,000 incident AIDS cases. The drug costs of this intervention would, however, be more than $19 billion at present prices, and would require 12.5% of the country's per-person health-care expenditure | ||
| 520 | |a INTERPRETATION: Although there are barriers to widespread HIV-1 treatment, limited use of antiretrovirals could have an immediate and substantial impact on South Africa's AIDS epidemic | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Acquired Immunodeficiency Syndrome | |
| 650 | 4 | |a Africa | |
| 650 | 4 | |a Africa South Of The Sahara | |
| 650 | 4 | |a Demographic Factors | |
| 650 | 4 | |a Demographic Impact | |
| 650 | 4 | |a Developing Countries | |
| 650 | 4 | |a Diseases | |
| 650 | 4 | |a Drugs | |
| 650 | 4 | |a English Speaking Africa | |
| 650 | 4 | |a Epidemics | |
| 650 | 4 | |a Hiv Infections | |
| 650 | 4 | |a Models, Experimental | |
| 650 | 4 | |a Population | |
| 650 | 4 | |a Population Dynamics | |
| 650 | 4 | |a Research Methodology | |
| 650 | 4 | |a Research Report | |
| 650 | 4 | |a South Africa | |
| 650 | 4 | |a Southern Africa | |
| 650 | 4 | |a Treatment | |
| 650 | 4 | |a Viral Diseases | |
| 650 | 7 | |a Anti-HIV Agents |2 NLM | |
| 700 | 1 | |a Braitstein, P |e verfasserin |4 aut | |
| 700 | 1 | |a Montaner, J S |e verfasserin |4 aut | |
| 700 | 1 | |a Schechter, M T |e verfasserin |4 aut | |
| 700 | 1 | |a Tyndall, M W |e verfasserin |4 aut | |
| 700 | 1 | |a O'Shaughnessy, M V |e verfasserin |4 aut | |
| 700 | 1 | |a Hogg, R S |e verfasserin |4 aut | |
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