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. 2014 Mar;33(3):362-9.
doi: 10.1377/hlthaff.2013.0830.

Early HIV treatment in the United States prevented nearly 13,500 infections per year during 1996-2009

Dana P Goldman, Timothy Juday, Daniel Seekins, Mark T Linthicum, John A Romley

Early HIV treatment in the United States prevented nearly 13,500 infections per year during 1996-2009

Dana P Goldman et al. Health Aff (Millwood). 2014 Mar.

Abstract

In recent years, guidelines for HIV treatment have recommended initiation of combination antiretroviral therapy (cART) earlier in the course of the disease than was previously the case. These recommendations stem in part from growing evidence that treatment reduces the risk of sexual transmission. We used an epidemiological model of disease transmission and progression to assess HIV prevention through early treatment-that is, initiation of cART when CD4 white blood cell counts are in excess of 350 cells per cubic millimeter. (CD4 cells are involved in the immune system's defense against tumors and infection; the number of CD4 cells in a cubic millimeter of blood is a standard measure of immune response to antiretroviral therapy.) We estimated that the actual timing of treatment initiation in the United States prevented 188,000 HIV cases in the period 1996-2009. "Very early" treatment (at CD4 counts greater than 500) accounted for four-fifths of the prevented cases. For all of the prevented cases, the losses in life expectancy that were avoided were worth $128 billion, assuming that a life-year has a value of $150,000. These findings underscore the cost-effectiveness of early HIV treatment.

Keywords: AIDS/HIV; Consumer Issues; Health Promotion/Disease Prevention; Health Reform; Public Health.

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Figures

Exhibit 1
Exhibit 1. Actual And Predicted HIV Incidence In The United States, 1996-2009
SOURCE Authors’ calculations. NOTES Actual HIV incidence is based on published estimates of incidence. Predicted incidence is the incidence predicted by the authors’ model, described in the text.
Exhibit 2
Exhibit 2. Predicted HIV Incidence In The United States, 1996-2009, With And Without Early Treatment
SOURCE Authors’ calculations. NOTES Actual treatment is the estimated rate of treatment with combination antiretroviral therapy (cART), according to CD4 count over 1996-2009. No early treatment is treatment at CD4 counts of less than 350 cells/mm3 only. No very early treatment is treatment at CD4 counts of less than 500 cells/mm3 only.
Exhibit 3
Exhibit 3. Value Of A Case Of HIV In The United States Prevented Through Early
SOURCE Authors’ calculations. NOTE Assuming treatment with combination antiretroviral therapy (cART) at CD4 counts of less than 350 cells/mm3 only.
Exhibit 4
Exhibit 4. Total Value Of All Cases Of HIV In The United States Prevented Through Early Treatment, 1996-2009
SOURCE Authors’ calculations. NOTE Assuming treatment with combination antiretroviral therapy (cART) at CD4 counts of less than 350 cells/mm3 only.
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