Document Detail

HIV antiretroviral treatment: early versus later.
MedLine Citation:
PMID:  16044008     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Cohort studies indicate that starting highly active antiretroviral therapy (HAART) when the CD4+ T-cell count is less than 200 cells/muL is associated with poor outcomes. These studies have been unable to address how early HAART should be initiated, however. This report uses a modeling approach to compare starting HAART at a mean CD4+ T-cell count greater than 350 cells/microL (early) versus less than 350 cells/microL but greater than 200 cells/microL (later). METHODS: A Markov model tracks people with HIV infection through 6 disease stages defined by CD4+ T-cell count ranges over a 25-year period. Transition probabilities between the disease stages for 6-month periods vary according to initial viral load. Sequences of different first-line, second-line, and "salvage" antiretroviral regimens are defined, and their impact on transition probabilities is estimated. HAART effectiveness is based on data from an urban hospital-based HIV clinic, supplemented by clinical trial data. The model computes the incremental cost-effectiveness of alternative treatment patterns and includes sensitivity analyses for a range of plausible alternative input values. RESULTS: Starting HAART earlier rather than later increases total lifetime costs by $19,074, increases years of life by 1.21 years, increases discounted quality-adjusted life-years by 0.61, and has an incremental cost-effectiveness ratio of $31,266 per quality-adjusted life-year. Early therapy is more cost-effective when the impact of HAART on well-being is smaller. CONCLUSIONS: Initiation of HAART at a CD4+ T-cell count greater than 350 cells/microL may be cost-effective (less than $50,000 per quality-adjusted life-year) compared with initiating HAART at a CD4+ T-cell count less than 350 cells/microL but greater than 200 cells/muL and may result in longer quality-adjusted survival.
Josephine Mauskopf; Mari Kitahata; Teresa Kauf; Anke Richter; Jerry Tolson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  39     ISSN:  1525-4135     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-26     Completed Date:  2005-09-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  562-9     Citation Subset:  IM; X    
RTI Health Solutions, Research Triangle Park, NC 27709, USA.
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MeSH Terms
Antiretroviral Therapy, Highly Active / economics*,  methods*
CD4 Lymphocyte Count
Cost-Benefit Analysis
Drug Administration Schedule
HIV Infections / drug therapy*
Markov Chains
Models, Statistical
Quality of Life
Viral Load

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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