New data from a landmark clinical trial that established early treatment for HIV infection as an effective way to prevent transmission of the virus now show that this treatment-as-prevention approach is cost-effective, too.
Presented today at the XIX International AIDS Conference in Washington, DC, the findings are from the HIV Prevention Trials Network (HPTN) 052 study of serodiscordant couples. The trial enrolled 1763 couples, most heterosexual, at 13 sites in Africa, South America, Asia, and the United States. When enrollment began in 2005, infected partners had CD4 cell counts between 350 and 550 cells/mL. The couples were randomly assigned to 1 of 2 groups: immediate antiretroviral treatment (ART) for the infected partner or treatment delayed until the infected partner had a CD4 cell count below 250 cells/mL or an AIDS-defining illness. Data released last year showed that early treatment led to a 96% reduction in HIV transmission to uninfected partners.
Those findings led to revisions in US and World Health Organization (WHO) treatment guidelines but also raised questions about the cost-effectiveness of early treatment. So HPTN 052 investigators used a computer simulation to estimate the economic consequences of their clinical trial results. They produced cost-effectiveness models based on trial results from South Africa and India to determine whether regional economic differences would change the conclusions.
The models showed that in both countries, early ART increased survival, prevented costly opportunistic infections, and averted HIV transmissions. By doing so, the lifetime cost of early ART was $530 in each country for every year of life it saved. That figure is well below each country’s per capita gross domestic product (GDP), which is the WHO’s threshold for a therapy to be considered very cost-effective. The per capita GDP is $8100 in South Africa and $1400 in India.
Lead author Rochelle Walensky, MD, MPH, associate director of epidemiology and outcomes research at the Harvard Center for AIDS Research, Boston, noted that WHO treatment guidelines are backed primarily by evidence from clinical studies but are beginning to take economic data into consideration.
Walensky said in an interview that she’d like to see the data presented today “be the nail in the coffin” on any doubts about the benefits of early ART. “Not only do we have good clinical data to support it, but now we know that it also is a very good investment.”