A review analyzing data from around the world on adults living with HIV in low- and middle-income countries found that initiation of antiretroviral treatment lowered the risks of opportunistic infections during the first year of treatment from as much as 57 percent to 91 percent, saving millions of dollars in costs of treating illnesses that include pneumonia, fungal infections, parasitic infections and tuberculosis. The observed impact of HIV treatment in averting serious illnesses was greater than that seen in high-income countries and showed that levels of adherence to treatment and immune system recovery were comparable across low and high-income countries.
The analysis, reported in Clinical Infectious Diseases, estimated that antiretroviral treatment access saved from $46 million to more than $49 million in costs for treating six common opportunistic infections, with the greatest savings, of an estimated $33 million, stemming from averted tuberculosis cases in 2013 alone.
While the impact of antiretroviral treatment on rates of HIV-associated illness and death in higher income countries has been observed and documented, the authors say, how access to treatment has affected health needs across lower income countries has not been adequately scrutinized. They add that doing so is critical to health service planning and procurement, as well as to estimate the cost impact of timely and equitable access to life-saving treatment.
To report Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low- and Middle-Income Countries researchers identified more than 7,000 articles addressing the topic, and analyzed 126 selected for relevance and sufficient data, describing cases from 1990 to 2013. They conclude that the data show that access to antiretroviral treatment is the key reason for global decreases in HIV-related deaths, and illustrate the continued importance of expanding access to the treatment. Treatment for all people living with HIV, according to the article, would avert 21 million AIDS-related deaths by 2030. In the meantime, they note, while significant numbers of people living with HIV are diagnosed or treated until their illness is advanced, screening and preventive treatment for opportunistic infections remains critical.
The authors, led by Andrea Low of ICAP at Columbia University and the London School of Hygiene and Tropical Medicine, call the study, based on the analysis of almost half a million adults living with HIV worldwide, the most comprehensive global assessment so far on the effect of antiretroviral treatment on 15 opportunistic infections.