Modeling the impact of early antiretroviral therapy for adults coinfected with HIV and hepatitis B or C in South Africa.


Martin, NK; Devine, A; Eaton, JW; Miners, A; Hallett, TB; Foster, GR; Dore, GJ; Easterbrook, PJ; Legood, R; Vickerman, P; (2014) Modeling the impact of early antiretroviral therapy for adults coinfected with HIV and hepatitis B or C in South Africa. AIDS (London, England), 28 Suppl 1. S35-46. ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0000000000000084

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Abstract

OBJECTIVE There has been discussion about whether individuals coinfected with HIV and hepatitis C virus (HCV) or hepatitis B virus (HBV) (∼30% of all people living with HIV) should be prioritized for early HIV antiretroviral therapy (ART). We assess the relative benefits of providing ART at CD4 count below 500 cells/μl or immediate ART to HCV/HIV or HBV/HIV-coinfected adults compared with HIV-monoinfected adults. We evaluate individual outcomes (HIV/liver disease progression) and preventive benefits in a generalized HIV epidemic setting. METHODS We modeled disease progression for HIV-monoinfected, HBV/HIV-coinfected, and HCV/HIV-coinfected adults for differing ART eligibility thresholds (CD4 <350 cells/μl, CD4 <500 cells/μl, immediate ART eligibility upon infection). We report disability-adjusted life-years averted per 100 person-years on ART (DALYaverted/100PYonART) as a measure of the health benefits generated from incremental changes in ART eligibility. Sensitivity analyses explored impact on sexual HIV and vertical HIV, HCV, and HBV transmission. RESULTS For HBV/HIV-coinfected adults, a switch to ART initiation at CD4 count below 500 cells/μl from CD4 below 350 cells/μl generates 9% greater health benefits per year on ART (48 DALYaverted/100PYonART) than for HIV-monoinfected adults (44 DALYaverted/100PYonART). Additionally, ART at CD4 below 500 cells/μl could prevent 25% and 32% of vertical transmissions of HIV and HBV, respectively. For HCV/HIV-coinfected adults, ART at CD4 below 500 cells/μl generates 10% fewer health benefits (40 DALYaverted/100PYonART) than for HIV monoinfection, unless ART reduces progression to cirrhosis by more than 70% (33% in base-case). CONCLUSIONS The additional therapeutic benefits of ART for HBV-related liver disease results in ART generating more health benefits among HBV/HIV-coinfected adults than HIV-monoinfected individuals, whereas less health benefits are generated amongst HCV/HIV coinfection in a generalized HIV epidemic setting.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
Research Centre: Social and Mathematical Epidemiology (SaME)
SaME Modelling & Economics
PubMed ID: 24468945
Web of Science ID: 334160100005
URI: http://researchonline.lshtm.ac.uk/id/eprint/1496199

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