Analysis shows death rate divide for those with and without earlier access to HIV treatment

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Comparison shows that in 2013, an estimated 65 of every thousand people living with HIV in Nigeria died, a rate as much as 13 times that of higher income countries

Ensuring that in the next five years, 90 percent of people living with HIV in South Africa are aware of their infections, 90 percent of them are receiving antiretroviral treatment, and that treatment is consistently accessible and effective enough to suppress the virus in 90 percent of them, could save the lives of 2.2 million people in that country alone, a study released Monday says. Doing the same thing in Nigeria could avert another 1.2 million deaths, according to the study.

Those are just two of 30 countries with the highest rates of AIDS-related deaths that worldwide accounted for 87 percent of the global pandemic’s death toll in 2013. Researchers used data on numbers of people living with HIV, becoming infected with the virus, and dying of AIDS-related causes in those countries, as well as the numbers of people living with HIV receiving the antiretroviral treatment in each country, to examine the relationship between access to early treatment for HIV and deaths resulting from the virus. While guidelines in high-income countries that include the United States recommend immediate access to antiretroviral treatment upon HIV diagnosis, people living with HIV in many of the countries with the highest HIV-related death rates gain access to antiretroviral treatment only upon evidence of immune system damage.

The report on the study, Trends in AIDS Deaths, New Infections and ART Coverage in the Top 30 Countries with the Highest AIDS Mortality Burden; 1990-2013, was published Monday on PLOS ONE.

Researchers found that while efforts to expand access to treatment for HIV in the last decade has saved millions of lives, opportunities to save millions more lives through early access to treatment are not being realized. The study presents a comparison of striking divergence in AIDS-related death rates for selected low, middle, and high-income countries, showing 65 of every thousand people living with HIV in Nigeria dying in 2013, while 31 out of every thousand people living with HIV in South Africa died, 18 of every thousand in Botswana, 15-17 of every thousand in the U.S. and around five in every thousand people with HIV in Germany, the United Kingdom and Spain.

“Our estimates illustrate the unacceptably high annual AIDS-related death rate in many geographic settings and the growing divide between those with and those without earlier access to life-saving [antiretroviral treatment],” the authors noted.

The release of the study’s findings follow those from the START study showing that Strategic Timing of Antiretroviral Treatment as early as possible cuts risks of serious illnesses and deaths by more than half. That study compared outcomes among trial participants who started antiretroviral treatment immediately, and those who were provided treatment according to guidelines based on lowered immune, or CD4, count, showing the virus had already damaged their immune systems.

The analysis underscores, that early initiation of treatment “nets greater benefit than waiting for now obsolete [antiretroviral treatment] thresholds based on CD4 cell counts,” Dr. Reuben Granich, vice president and chief technical officer of the International Association of Providers of AIDS Care, and the article’s lead author, said in a statement released with the findings.

“Given the benefits of early ART initiation, it is an appalling human rights violation that far too many HIV-positive people are dying unnecessarily in so many countries around the globe,” IAPAC President and CEO, and article co-author José M. Zuniga said in the statement.

The study adds to projections by UNAIDS that achieving those 90-90-90 HIV diagnosis, treatment and viral suppression goals by 2020 would effectively end the global pandemic by 2030.

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