The landmark HPTN 052 study, which proved in 2011 that treating HIV also prevents transmission of the virus, continues to be the gift that keeps on giving, with data from the multi-site trial now showing that early treatment is cost-effective as well, results of a just-released analysis reported in the New England Journal of Medicine says.
Dr. Rochelle Walensky, corresponding author of the NEJM report, called the conclusions exciting, noting that recently updated World Health Organization guidelines recommending earlier antiretroviral treatment initiation have not been widely adopted, and that evidence the move can be cost effective can help inform decisions.
The analysis used HPTN 052 data from South Africa and India to compare two-year, five-year, and expected lifetime outcomes for HIV-infected patients started on antiretroviral drugs when their immune cell counts were still between 350 to 500 per cubic millimeter of blood with those for patients whose immune systems were already more damaged when they started treatment with immune cell counts under 250 per cubic millimeter of blood. The analysis projected costs of treatment, care for illnesses, and costs associated with new infections.
Starting antiretroviral treatment earlier was actually found to save money in South Africa for the first five years of treatment, the study found, with benefits to individuals, public health and economic benefits, by averting illnesses that require expensive treatment, and preventing transmissions. In India, where treatments for opportunistic infections, including tuberculosis, are less expensive, early antiretroviral treatment was found to be cost effective during those first five years. Longer term projections from data in both sites showed early treatment to be cost effective — with the costs of maintaining antiretroviral treatment exceeding the costs of care for opportunistic infections, but mitigated by fewer costs that came with higher rates of transmissions, illnesses and infections among those who started treatment later — providing good economic value in the long run.