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SURVIVAL BENEFITS OF ANTIRETROVIRAL THERAPY IN BRAZIL: A MODEL-BASED ANALYSIS
Luz, Paula M. et al. | Date Issued: 2016
Author
Luz, Paula M.
Girouard, Michael P.
Grinsztejn, Beatriz
Freedberg, Kenneth A.
Veloso, Valdiléa G.
Losina, Elena
Struchiner, Claudio J.
MacLean, Rachel L.
Parker, Robert A.
Paltiel, A. David
Walensky, Rochelle P.
Affilliation
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Medical Practice Evaluation Center, Massachusetts General Hospital Boston, MA, USA./ Division of General Internal Medicine, Massachusetts General Hospital Boston, MA, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Medical Practice Evaluation Center, Massachusetts General Hospital Boston, MA, USA / Division of General Internal Medicine, Massachusetts General Hospital Boston, MA, USA / Division of Infectious Disease, Massachusetts General Hospital Boston, MA, USA / Harvard University Center for AIDS Research, Harvard Medical School Boston, MA, USA / Department of Epidemiology, Boston University School of Public Health Boston, MA, USA / Department of Health Policy and Management, Harvard School of Public Health Boston, MA, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Medical Practice Evaluation Center, Massachusetts General Hospital Boston, MA, USA / Harvard University Center for AIDS Research, Harvard Medical School Boston, MA, USA / Department of Orthopedic Surgery, Brigham and Women's Hospital Boston, MA, USA / Department of Biostatistics, Boston University School of Public Health Boston, MA, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Medical Practice Evaluation Center, Massachusetts General Hospital Boston, MA, USA./ Division of General Internal Medicine, Massachusetts General Hospital Boston, MA, USA.
Medical Practice Evaluation Center, Massachusetts General Hospital Boston, MA, USA./ Harvard University Center for AIDS Research, Harvard Medical School Boston, MA, USA / Biostatistics Center, Massachusetts General Hospital Boston, MA, USA.
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
Medical Practice Evaluation Center, Massachusetts General Hospital Boston, MA, USA./ Division of General Internal Medicine, Massachusetts General Hospital Boston, MA, USA / Division of Infectious Disease, Massachusetts General Hospital Boston, MA, USA / Harvard University Center for AIDS Research, Harvard Medical School Boston, MA, USA / Division of Infectious Disease, Brigham and Women's Hospital Boston, MA, USA.
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.
Keywords
Brazil
HIV
Latin America
Highly active antiretroviral therapy
Modelling
Survival
 
Citation
LUZ, P. M. et al. Survival benefits of antiretroviral therapy in Brazil: a model-based analysis. Journal of the International AIDS Society, v. 19, n. 1, p. 1-11, 2016.
DOI
10.7448/IAS.19.1.20623
ISSN
1758-2652