Dataset Information

Survival benefits of antiretroviral therapy in Brazil: a model-based analysis.

ABSTRACT:

Objective

In Brazil, universal provision of antiretroviral therapy (ART) has been guaranteed free of charge to eligible HIV-positive patients since December 1996. We sought to quantify the survival benefits of ART attributable to this programme.

Methods

We used a previously published microsimulation model of HIV disease and treatment (CEPAC-International) and data from Brazil to estimate life expectancy increase for HIV-positive patients initiating ART in Brazil. We divided the period of 1997 to 2014 into six eras reflecting increased drug regimen efficacy, regimen availability and era-specific mean CD4 count at ART initiation. Patients were simulated first without ART and then with ART. The 2014-censored and lifetime survival benefits attributable to ART in each era were calculated as the product of the number of patients initiating ART in a given era and the increase in life expectancy attributable to ART in that era.

Results

In total, we estimated that 598,741 individuals initiated ART. Projected life expectancy increased from 2.7, 3.3, 4.1, 4.9, 5.5 and 7.1 years without ART to 11.0, 17.5, 20.7, 23.0, 25.3, and 27.0 years with ART in Eras 1 through 6, respectively. Of the total projected lifetime survival benefit of 9.3 million life-years, 16% (or 1.5 million life-years) has been realized as of December 2014.

Conclusions

Provision of ART through a national programme has led to dramatic survival benefits in Brazil, the majority of which are still to be realized. Improvements in initial and subsequent ART regimens and higher CD4 counts at ART initiation have contributed to these increasing benefits.

SUBMITTER: Luz PM

PROVIDER: S-EPMC4814587 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Publications

Survival benefits of antiretroviral therapy in Brazil: a model-based analysis.

Luz Paula M PM Girouard Michael P MP Grinsztejn Beatriz B Freedberg Kenneth A KA Veloso Valdilea G VG Losina Elena E Struchiner Claudio J CJ MacLean Rachel L RL Parker Robert A RA Paltiel A David AD Walensky Rochelle P RP

Journal of the International AIDS Society 20160329 1

<h4>Objective</h4>In Brazil, universal provision of antiretroviral therapy (ART) has been guaranteed free of charge to eligible HIV-positive patients since December 1996. We sought to quantify the survival benefits of ART attributable to this programme.<h4>Methods</h4>We used a previously published microsimulation model of HIV disease and treatment (CEPAC-International) and data from Brazil to estimate life expectancy increase for HIV-positive patients initiating ART in Brazil. We divided the pe ...[more]

PMID: 27029828

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Dataset Information

Survival benefits of antiretroviral therapy in Brazil: a model-based analysis.

Objective

Methods

Results

Conclusions

Publications

Survival benefits of antiretroviral therapy in Brazil: a model-based analysis.

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