POZLife: Life from the Infected and Effected point of veiw.

AIDS Drugs Have Saved 3 Million Years of Life

Posted by pozlife on June 5, 2006

National Institute of Allergy and
Infectious Diseases (NIAID)
Friday, June 2, 2006
Media Contact:
Anne A. Oplinger
(301) 402-1663

HIV Disease Model Details Survival Benefits of HIV Therapies

Increasingly effective HIV therapy—including a decade of
highly active antiretroviral therapy (HAART)—has provided 3
million years of extended life to Americans with AIDS since 1989,
report researchers funded by the National Institute of Allergy and
Infectious Diseases (NIAID), part of the National Institutes of Health

Rochelle Walensky, M.D., M.P.H., Kenneth Freedberg, M.D., M.Sc., and
their colleagues calculated that advances in HIV care have yielded a
total survival benefit of 2.8 million years in the United States. The
researchers also estimate that drugs to prevent mother-to-child
transmission of HIV have averted 2,900 infant infections, saving an
additional 137,000 years of life. The model projected that a person
initiating HIV therapy in 2003 could expect to live more than 13 years
longer than if he or she had been diagnosed in 1988.

The paper by Drs. Walensky and Freedberg, of Massachusetts General
Hospital and the Harvard Medical School Center for AIDS Research, and
their coauthors has been posted online by The Journal of Infectious Diseases.

"Since the early 1980s, soon after the first reports of what we now
know as AIDS, NIH has devoted $30 billion to HIV/AIDS research," says
NIH Director Elias A. Zerhouni, M.D. "This study clearly shows the
dramatic impact that sustained investment in biomedical research can
have in improving the lives of Americans."

"As new HIV therapies have come into the clinic, we have witnessed
the transformation of HIV/AIDS from a rapidly fatal disease into a
controllable condition," notes NIAID Director Anthony S. Fauci, M.D.
"Although the rate of new infections in this country remains
unacceptably high, for many people, HIV infection is no longer the
death sentence it once was."

"Advances in HIV/AIDS treatments have been striking, particularly
over the past decade. Our goal in this study was to quantify the
clinical progress in AIDS care in terms of years of life saved," says
Dr. Walensky.

The researchers used a computer model, developed by Dr. Freedberg
and colleagues, that incorporates literature-based data of clinical
measures including HIV viral load, CD4+ T-cell counts (a measure of
immune system health), efficacy of HAART, and incidence of
opportunistic infections, to simulate HIV disease progression both with
and without treatment. Information about the number of people diagnosed
with AIDS and accessing health care each year between 1989 and 2003
came from U.S. Centers for Disease Control and Prevention surveillance
and other published data.

The investigators defined six eras of AIDS treatment between 1989
and 2003. In the first two periods, 1989 to 1992 and 1993 to 1995,
drugs became available to prevent two common infections—Pneumocyctis jirovecii pneumonia and Mycobacterium avium
complex. Although the drugs provided an average per-person survival
benefit during that time of only 2.6 months, those early eras helped to
shape the perception that AIDS was a treatable condition, notes Dr.
Freedberg. Drs. Walensky and Freedberg subdivided the HAART era, which
began in 1996, into four periods corresponding to increasingly
effective HAART and other advances in HIV care.

For each year of the six eras, the investigators ran simulations of
HIV disease progression in two equal-sized groups of hypothetical
people with AIDS. One group received no therapy, while the other group
received all available therapies of that era. The model calculated a
per-person survival benefit and a total survival benefit in each era.
By 2003, the model projected that an individual beginning treatment
that year could expect to live more than 13 years longer than if he or
she had been diagnosed in 1988. The total survival benefit for the
24,780 people diagnosed with AIDS and entering care in 2003 was 330,189
years. The total cumulative survival benefit across all eras from all
forms of HIV therapy was 2.8 million years.


Per person survival benefit, number of AIDS patients entering care and era-specific and cumulative survival benefits

1989-1992 PCP* prophylaxis 3.1 158,370 33% 40,912
1996-1997 PCP/MAC prophylaxis + ART 1 93.7 72,716 86% 567,788
2000-2002 PCP/MAC prophylaxis + ART 3 138.8 71,946 91% 832,179

: Pneumocystis jiroveci pneumonia
MAC: Mycobacterium avium complex
ART: antiretroviral therapy

Source: The survival benefits of AIDS treatment in the United States. RP Walensky et al.

Walensky emphatically notes, however, that survival benefits related to
therapy are available only to those with known HIV infection. But about
one-fourth of people in the United States infected with HIV are unaware
of their infection, she adds. "We calculated that a cohort of patients
presenting with AIDS at higher CD4 cell counts—simulating
slightly earlier entry into care—had an additional gain of
740,000 years of survival," says Dr. Walensky. "These findings
underscore the importance of expanded HIV testing and better linkage to
care for people who are HIV-infected, so that more of them can realize
the life-extending benefits of HIV therapies."

"This type of research can also be used to understand the
tremendous survival benefits that can be gained globally by continued
rapid expansion of access to these very effective HIV/AIDS treatments
in resource-limited settings," adds Dr. Freedberg. "This expansion is
of critical importance."

The National Institute on Drug Abuse and the National Institute of
Mental Health, parts of the NIH, also provided support for this

NIAID is a component of the National Institutes of Health. NIAID
supports basic and applied research to prevent, diagnose and treat
infectious diseases such as HIV/AIDS and other sexually transmitted
infections, influenza, tuberculosis, malaria and illness from potential
agents of bioterrorism. NIAID also supports research on basic
immunology, transplantation and immune-related disorders, including
autoimmune diseases, asthma and allergies.

The National Institutes of Health (NIH)—The Nation's Medical Research Agency—includes
27 Institutes and Centers and is a component of the U. S. Department of
Health and Human Services. It is the primary federal agency for
conducting and supporting basic, clinical and translational medical
research, and it investigates the causes, treatments and cures for both
common and rare diseases. For more information about NIH and its
programs, visit http://www.nih.gov


Reference: RP Walensky et al. The survival benefits of AIDS treatment in the United States. The Journal of Infectious Diseases. Published online June 1, 2006. http://www.journals.uchicago.edu/JID/journal/issues/v194n1/35845/35845.html
Additional Information: NIAID Exploring: Treatment of HIV Infection http://www.niaid.nih.gov/factsheets/treat-hiv.htm

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