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Science : Antiretroviral Therapy for HIV Worth the Price

Two new studies in this week’s issue of the journal Science demonstrate that the scaling up of HIV antiretroviral treatments in the rural province of KwaZulu-Natal, South Africa has been worth the hefty price tag.

Jacob Bor at Harvard University and colleagues followed up on the landmark HIV Prevention Trials Network 052 trial, or HPTN 052, which showed that people infected with HIV are 96% less likely to transmit the virus to their partners if they take antiretroviral (ART) drugs. Bor and colleagues now show that the life expectancy of adults in KwaZulu-Natal has increased by 11.3 years since the antiretroviral treatments were expanded in the region.

Such treatments cost somewhere between $US 500 and $900 per person each year, so there has been much debate over whether a scale-up of such treatments would be justified. The researchers analyzed changes in adult life expectancy within a population of approximately 100,000 people between 2000 and 2011—four years prior to and eight years after antiretroviral treatments were scaled up in the region—and determined that the survival benefits of antiretroviral treatments exceeded the cost of the treatments 26 times over.

They also found that the changes in life expectancy were due almost exclusively to changes in HIV-related deaths. “Many people have been worried that the ART scale-up, which is a massive public health intervention, would negatively affect populations who do not suffer from HIV but need care for other diseases,” Bor said in a related news release from the Harvard School of Public Health. “We do not find any evidence to support this worry.”

The study does have many inherent limitations because, as antiretroviral treatments were being scaled up in KwaZulu-Natal, access to clean water and electricity was also improving. However, even in a worst-case scenario, expanding antiretroviral treatments in southern Africa would help to save both lives and money, according to the researchers.

In a separate study, Frank Tanser and colleagues found that the risk of acquiring HIV in a sub-Saharan setting was significantly reduced when antiretroviral treatments were scaled up.

These researchers followed up on a study of nearly 17,000 uninfected individuals in KwaZulu-Natal for eight years after antiretroviral treatments were expanded in 2004. They found that uninfected individuals were 38% less likely to acquire the virus when they lived in areas of high antiretroviral coverage, compared to areas of low coverage.

Read the abstract, “Increases in Adult Life Expectancy in Rural South Africa: Valuing the Scale-Up of HIV Treatment,” by Jacob Bor and colleagues.

Read the abstract, “High Coverage of ART Associated with Decline in Risk of HIV Acquisition in Rural KwaZulu-Natal, South Africa,” by Frank Tanser and colleagues.

Listen to a related Science Podcast interview with Jacob Bor.