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Survival benefits of antiretroviral therapy in Brazil: a model-based analysis.

Luz PM, Girouard MP, Grinsztejn B, Freedberg KA, Veloso VG, Losina E, Struchiner CJ, MacLean RL, Parker RA, Paltiel AD, Walensky RP - J Int AIDS Soc (2016)

Bottom Line: Of the total projected lifetime survival benefit of 9.3 million life-years, 16% (or 1.5 million life-years) has been realized as of December 2014.Provision of ART through a national programme has led to dramatic survival benefits in Brazil, the majority of which are still to be realized.Improvements in initial and subsequent ART regimens and higher CD4 counts at ART initiation have contributed to these increasing benefits.

View Article: PubMed Central - PubMed

Affiliation: The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil; paula.luz@ipec.fiocruz.br.

ABSTRACT

Objective: In Brazil, universal provision of antiretroviral therapy (ART) has been guaranteed free of charge to eligible HIV-positive patients since December 1996. We sought to quantify the survival benefits of ART attributable to this programme.

Methods: We used a previously published microsimulation model of HIV disease and treatment (CEPAC-International) and data from Brazil to estimate life expectancy increase for HIV-positive patients initiating ART in Brazil. We divided the period of 1997 to 2014 into six eras reflecting increased drug regimen efficacy, regimen availability and era-specific mean CD4 count at ART initiation. Patients were simulated first without ART and then with ART. The 2014-censored and lifetime survival benefits attributable to ART in each era were calculated as the product of the number of patients initiating ART in a given era and the increase in life expectancy attributable to ART in that era.

Results: In total, we estimated that 598,741 individuals initiated ART. Projected life expectancy increased from 2.7, 3.3, 4.1, 4.9, 5.5 and 7.1 years without ART to 11.0, 17.5, 20.7, 23.0, 25.3, and 27.0 years with ART in Eras 1 through 6, respectively. Of the total projected lifetime survival benefit of 9.3 million life-years, 16% (or 1.5 million life-years) has been realized as of December 2014.

Conclusions: Provision of ART through a national programme has led to dramatic survival benefits in Brazil, the majority of which are still to be realized. Improvements in initial and subsequent ART regimens and higher CD4 counts at ART initiation have contributed to these increasing benefits.

No MeSH data available.


Related in: MedlinePlus

Years of life saved per-person in each era produced by model simulations.Bar width corresponds to the number of patients in each era and total coloured area corresponds to lifetime survival benefits. Survival benefits realized as of December 2014 are shaded with diagonal lines. YLS: years of life saved; ART: antiretroviral therapy.
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Figure 0001: Years of life saved per-person in each era produced by model simulations.Bar width corresponds to the number of patients in each era and total coloured area corresponds to lifetime survival benefits. Survival benefits realized as of December 2014 are shaded with diagonal lines. YLS: years of life saved; ART: antiretroviral therapy.

Mentions: For lifetime outcomes, Era 1 had a life expectancy of 2.7 years without ART compared to 11.0 years with ART, for a per-person increase of 8.3 years (Table 3, columns B′–D′). Per-person survival benefits for subsequent eras were even greater, ranging from 14.2 years for Era 2 to 19.9 years for Era 6. Per-person life expectancy in each era is illustrated in Figure 1, as is the survival benefit attributable to ART availability in each era compared to no ART and compared to the era immediately before. Increased per-person survival yielded a total population anticipated lifetime survival benefit of 9.3 million life-years, 7.8 million (84%) of which have yet to be realized (Figure 1).


Survival benefits of antiretroviral therapy in Brazil: a model-based analysis.

Luz PM, Girouard MP, Grinsztejn B, Freedberg KA, Veloso VG, Losina E, Struchiner CJ, MacLean RL, Parker RA, Paltiel AD, Walensky RP - J Int AIDS Soc (2016)

Years of life saved per-person in each era produced by model simulations.Bar width corresponds to the number of patients in each era and total coloured area corresponds to lifetime survival benefits. Survival benefits realized as of December 2014 are shaded with diagonal lines. YLS: years of life saved; ART: antiretroviral therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4814587&req=5

Figure 0001: Years of life saved per-person in each era produced by model simulations.Bar width corresponds to the number of patients in each era and total coloured area corresponds to lifetime survival benefits. Survival benefits realized as of December 2014 are shaded with diagonal lines. YLS: years of life saved; ART: antiretroviral therapy.
Mentions: For lifetime outcomes, Era 1 had a life expectancy of 2.7 years without ART compared to 11.0 years with ART, for a per-person increase of 8.3 years (Table 3, columns B′–D′). Per-person survival benefits for subsequent eras were even greater, ranging from 14.2 years for Era 2 to 19.9 years for Era 6. Per-person life expectancy in each era is illustrated in Figure 1, as is the survival benefit attributable to ART availability in each era compared to no ART and compared to the era immediately before. Increased per-person survival yielded a total population anticipated lifetime survival benefit of 9.3 million life-years, 7.8 million (84%) of which have yet to be realized (Figure 1).

Bottom Line: Of the total projected lifetime survival benefit of 9.3 million life-years, 16% (or 1.5 million life-years) has been realized as of December 2014.Provision of ART through a national programme has led to dramatic survival benefits in Brazil, the majority of which are still to be realized.Improvements in initial and subsequent ART regimens and higher CD4 counts at ART initiation have contributed to these increasing benefits.

View Article: PubMed Central - PubMed

Affiliation: The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil; paula.luz@ipec.fiocruz.br.

ABSTRACT

Objective: In Brazil, universal provision of antiretroviral therapy (ART) has been guaranteed free of charge to eligible HIV-positive patients since December 1996. We sought to quantify the survival benefits of ART attributable to this programme.

Methods: We used a previously published microsimulation model of HIV disease and treatment (CEPAC-International) and data from Brazil to estimate life expectancy increase for HIV-positive patients initiating ART in Brazil. We divided the period of 1997 to 2014 into six eras reflecting increased drug regimen efficacy, regimen availability and era-specific mean CD4 count at ART initiation. Patients were simulated first without ART and then with ART. The 2014-censored and lifetime survival benefits attributable to ART in each era were calculated as the product of the number of patients initiating ART in a given era and the increase in life expectancy attributable to ART in that era.

Results: In total, we estimated that 598,741 individuals initiated ART. Projected life expectancy increased from 2.7, 3.3, 4.1, 4.9, 5.5 and 7.1 years without ART to 11.0, 17.5, 20.7, 23.0, 25.3, and 27.0 years with ART in Eras 1 through 6, respectively. Of the total projected lifetime survival benefit of 9.3 million life-years, 16% (or 1.5 million life-years) has been realized as of December 2014.

Conclusions: Provision of ART through a national programme has led to dramatic survival benefits in Brazil, the majority of which are still to be realized. Improvements in initial and subsequent ART regimens and higher CD4 counts at ART initiation have contributed to these increasing benefits.

No MeSH data available.


Related in: MedlinePlus