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Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy

BACKGROUND: International HIV guidelines have recently shifted from a medium-late to an early-start treatment strategy. As a consequence, more people will be eligible to Highly Active Antiretroviral Therapy (HAART). We estimate mean life years gained using different treatment indications in low inco...

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Autores principales: Johansson, Kjell Arne, Robberstad, Bjarne, Norheim, Ole Frithjof
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836271/
https://www.ncbi.nlm.nih.gov/pubmed/20180966
http://dx.doi.org/10.1186/1742-6405-7-3
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author Johansson, Kjell Arne
Robberstad, Bjarne
Norheim, Ole Frithjof
author_facet Johansson, Kjell Arne
Robberstad, Bjarne
Norheim, Ole Frithjof
author_sort Johansson, Kjell Arne
collection PubMed
description BACKGROUND: International HIV guidelines have recently shifted from a medium-late to an early-start treatment strategy. As a consequence, more people will be eligible to Highly Active Antiretroviral Therapy (HAART). We estimate mean life years gained using different treatment indications in low income countries. METHODS: We carried out a systematic search to identify relevant studies on the treatment effect of HAART. Outcome from identified observational studies were combined in a pooled-analyses and we apply these data in a Markov life cycle model based on a hypothetical Tanzanian HIV population. Survival for three different HIV populations with and without any treatment is estimated. The number of patients included in our pooled-analysis is 35 047. RESULTS: Providing HAART early when CD4 is 200-350 cells/μl is likely to be the best outcome strategy with an expected net benefit of 14.5 life years per patient. The model predicts diminishing treatment benefits for patients starting treatment when CD4 counts are lower. Patients starting treatment at CD4 50-199 and <50 cells/μl have expected net health benefits of 7.6 and 7.3 life years. Without treatment, HIV patients with CD4 counts 200-350; 50-199 and < 50 cells/μl can expect to live 4.8; 2.0 and 0.7 life years respectively. CONCLUSIONS: This study demonstrates that HIV patients live longer with early start strategies in low income countries. Since low income countries have many constraints to full coverage of HAART, this study provides input to a more transparent debate regarding where to draw explicit eligibility criteria during further scale up of HAART.
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spelling pubmed-28362712010-03-11 Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy Johansson, Kjell Arne Robberstad, Bjarne Norheim, Ole Frithjof AIDS Res Ther Research BACKGROUND: International HIV guidelines have recently shifted from a medium-late to an early-start treatment strategy. As a consequence, more people will be eligible to Highly Active Antiretroviral Therapy (HAART). We estimate mean life years gained using different treatment indications in low income countries. METHODS: We carried out a systematic search to identify relevant studies on the treatment effect of HAART. Outcome from identified observational studies were combined in a pooled-analyses and we apply these data in a Markov life cycle model based on a hypothetical Tanzanian HIV population. Survival for three different HIV populations with and without any treatment is estimated. The number of patients included in our pooled-analysis is 35 047. RESULTS: Providing HAART early when CD4 is 200-350 cells/μl is likely to be the best outcome strategy with an expected net benefit of 14.5 life years per patient. The model predicts diminishing treatment benefits for patients starting treatment when CD4 counts are lower. Patients starting treatment at CD4 50-199 and <50 cells/μl have expected net health benefits of 7.6 and 7.3 life years. Without treatment, HIV patients with CD4 counts 200-350; 50-199 and < 50 cells/μl can expect to live 4.8; 2.0 and 0.7 life years respectively. CONCLUSIONS: This study demonstrates that HIV patients live longer with early start strategies in low income countries. Since low income countries have many constraints to full coverage of HAART, this study provides input to a more transparent debate regarding where to draw explicit eligibility criteria during further scale up of HAART. BioMed Central 2010-01-16 /pmc/articles/PMC2836271/ /pubmed/20180966 http://dx.doi.org/10.1186/1742-6405-7-3 Text en Copyright ©2010 Johansson et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Johansson, Kjell Arne
Robberstad, Bjarne
Norheim, Ole Frithjof
Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy
title Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy
title_full Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy
title_fullStr Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy
title_full_unstemmed Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy
title_short Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy
title_sort further benefits by early start of hiv treatment in low income countries: survival estimates of early versus deferred antiretroviral therapy
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836271/
https://www.ncbi.nlm.nih.gov/pubmed/20180966
http://dx.doi.org/10.1186/1742-6405-7-3
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