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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

Tornado diagram of one-way sensitivity analyses of lifetime survival benefits of ART in Brazil.Each horizontal bar represents the range of survival benefits produced by varying a given model parameter across the ranges in parentheses. The vertical line represents the base case.
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Figure 0003: Tornado diagram of one-way sensitivity analyses of lifetime survival benefits of ART in Brazil.Each horizontal bar represents the range of survival benefits produced by varying a given model parameter across the ranges in parentheses. The vertical line represents the base case.

Mentions: Projected lifetime survival benefits were generally stable across the ranges of parameters examined (Figure 3). The most influential parameter was mean CD4 count at ART initiation for all eras; decreasing or increasing this by a relative 50% gave lifetime survival benefit estimates of 7.3 and 9.9 million life-years. Other influential parameters included the proportion of patients with >95% adherence (7.8 to 10.1 million life-years), ART failure at six months for all regimens (8.3 to 10.1 million life-years) and the percentage of patients starting ART with a history of OIs (8.8 to 9.7 million life-years). Rate of loss to follow-up and return to care did not substantially influence lifetime survival benefits. In the worst-case scenario, lifetime survival benefits were estimated at 5.5 million life-years. The best-case scenario yielded projected lifetime survival benefits of 11.1 million life-years.


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)

Tornado diagram of one-way sensitivity analyses of lifetime survival benefits of ART in Brazil.Each horizontal bar represents the range of survival benefits produced by varying a given model parameter across the ranges in parentheses. The vertical line represents the base case.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: Tornado diagram of one-way sensitivity analyses of lifetime survival benefits of ART in Brazil.Each horizontal bar represents the range of survival benefits produced by varying a given model parameter across the ranges in parentheses. The vertical line represents the base case.
Mentions: Projected lifetime survival benefits were generally stable across the ranges of parameters examined (Figure 3). The most influential parameter was mean CD4 count at ART initiation for all eras; decreasing or increasing this by a relative 50% gave lifetime survival benefit estimates of 7.3 and 9.9 million life-years. Other influential parameters included the proportion of patients with >95% adherence (7.8 to 10.1 million life-years), ART failure at six months for all regimens (8.3 to 10.1 million life-years) and the percentage of patients starting ART with a history of OIs (8.8 to 9.7 million life-years). Rate of loss to follow-up and return to care did not substantially influence lifetime survival benefits. In the worst-case scenario, lifetime survival benefits were estimated at 5.5 million life-years. The best-case scenario yielded projected lifetime survival benefits of 11.1 million life-years.

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