tailieunhanh - Báo cáo y học: "Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy"

Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy | Johansson et al. AIDS Research and Therapy 2010 7 3 http content 7 1 3 AIDS RESEARCH AND THERAPY RESEARCH Open Access Further benefits by early start of HIV treatment in low income countries Survival estimates of early versus deferred antiretroviral therapy Kjell Arne Johansson Bjarne Robberstad Ole Frithjof Norheim Abstract Background International HIV guidelines have recently shifted from a medium-late to an early-start treatment strategy. As a consequence more people will be eligible to Highly Active Antiretroviral Therapy HAART . We estimate mean life years gained using different treatment indications in low income countries. Methods We carried out a systematic search to identify relevant studies on the treatment effect of HAART. Outcome from identified observational studies were combined in a pooled-analyses and we apply these data in a Markov life cycle model based on a hypothetical Tanzanian HIV population. Survival for three different HIV populations with and without any treatment is estimated. The number of patients included in our pooled-analysis is 35 047. Results Providing HAART early when CD4 is 200-350 cells pl is likely to be the best outcome strategy with an expected net benefit of life years per patient. The model predicts diminishing treatment benefits for patients starting treatment when CD4 counts are lower. Patients starting treatment at CD4 50-199 and 50 cells pl have expected net health benefits of and life years. Without treatment HIV patients with CD4 counts 200-350 50199 and 50 cells pl can expect to live and life years respectively. Conclusions This study demonstrates that HIV patients live longer with early start strategies in low income countries. Since low income countries have many constraints to full coverage of HAART this study provides input to a more transparent debate regarding where to draw explicit eligibility criteria during further scale up of HAART. Background The optimal time