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Survival benefit of 9.2 million life-years attributed to Brazilian ART program

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SEATTLE — Universal ART offered in Brazil from 1997 to 2014 is estimated to have a population survival benefit of 9.2 million life-years, according to data presented at CROI 2015.

“Brazil’s national policy of free-of-charge ART access to patients has led to dramatic survival benefits, the vast majority of which have yet to be realized,” the researchers wrote. “Higher CD4 counts at ART initiation and improvements in initial and subsequent ART regimens have all contributed substantially to these benefits.”

Paula Mendes Luz, MD, PhD, of the Instituto Nacional de Infectologia Evandro Chagas in Rio de Janeiro, and colleagues used the CEPAC-International mathematical model to measure the life expectancy of Brazilian patients with HIV initiating ART since the program’s commencement. Input data was collected from the HIV Clinical Cohort at the Evandro Chagas Clinical Research Institute as well as government databases. To reflect policy changes and regimen improvements, the time frame was divided into six eras (1997-1999, 2000-2003, 2004-2007, 2008-2012, 2013, 2014). Cohorts of patients with characteristics reflective of their respective era were simulated from treatment initiation under two scenarios: without ART and with ART. The per-capita survival increase from ART was multiplied by the estimated number of patients initiating ART in that era to obtain the survival benefits.

Across 18 years, 618,500 HIV patients were estimated to have initiated ART in Brazil. Mean CD4 counts at the start of treatment ranged from 139/µL (1997-1999) to 510/µL (2014). As a result of ART, per-person life expectancy increased by 7 years, 13.5 years, 16.4 years, 17.9 years, 19.6 years, 18.9 years in each successive study era, assuming no further improvements in care over time. This resulted in an estimated population lifetime survival benefit of 9.2 million life-years, with 1.5 million life-years realized as of 2014.

“What would be a possible next step is not to only estimate the health benefits … but also the costs,” Luz told Infectious Disease News. “By doing so, we can see how cost effective this policy has been for Brazil alongside the improved survival benefits.” – by Dave Muoio

Reference: Luz PM, et al. Abstract 1119. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26, 2015; Seattle.

Disclosure: Luz reports no relevant financial disclosures.