Cost-effectiveness of HIV treatment

Increasing the number of people taking HIV treatment is highly cost effective, and could dramatically cut the number of new infections, Canadian researchers have calculated.

Treatment with antiretroviral drugs means that many people with HIV have a good chance of living a near normal lifespan.

It’s currently recommended that people should start taking anti-HIV drugs when their CD4 cell count is around 350. Starting therapy at this time – rather than waiting until later – cuts the risk of both HIV-related illness and some other serious diseases, such as those of the heart, kidneys and liver.

Therapy lowers the amount of virus in bodily fluids, so people who are successfully on treatment are generally less infectious.

Healthcare workers in the Canadian province of British Columbia are trying to increase the numbers of people on treatment amongst those patients with CD4 cell counts of 350 or below.

Researchers from the province have calculated that this policy could be highly cost-effective. If the proportion of eligible patients taking treatment was increased from 50 to 75%, US$900 million would be saved over 30 years.

In addition, increasing the number of treated patients could prevent 26% of new infections.

“All individuals who are eligible for an established life-saving treatment should receive it,” recommend the researchers.

Inflammation and HIV

Although antiretroviral treatment is highly effective, people with HIV have higher rates of some serious illnesses than their HIV-negative peers.

New research offers a possible explanation for this.

It showed that two markers of inflammation are associated with an increased risk of death for patients with HIV, even when they have a high CD4 cell count.

Researchers looked at levels of fibrinogen and C-reactive protein in over 900 patients taking HIV treatment.

Over the five years of the study, mortality rates were higher in patients with high levels of these markers of inflammation, even when their CD4 cell count was high. The researchers suggest that more investigations should be done to see whether treating this inflammation could help reduce the risk of early death.

The findings could have implications for the care of patients, suggesting that these markers of inflammation should be regularly checked.

Kidney disease

Kidney disease is an important cause of illness and death in people with HIV. Because of this, kidney function should be monitored regularly as part of routine HIV care. This means that problems can be spotted early and effective treatment provided.

The importance of such monitoring was confirmed by a US study involving 1415 HIV-positive women.

Its results demonstrated that women with kidney problems at the time they started HIV treatment were twice as likely to die prematurely than women with healthy kidneys at this time.

“Our study underscores the importance of early screening for kidney disease in HIV-infected women before HAART initiation,” conclude the researchers.

Those with kidney problems are especially encouraged to start HIV treatment when their CD4 cell count is around 350.

Atazanavir approved for children

The protease inhibitor atazanavir (Reyataz) is now an approved treatment for children aged six or over in the European Union.

It was endorsed after a trial showed that it was a safe and effective drug when used as part of combination HIV treatment.

The most common side-effect was an increase in a substance called bilirubin, produced by the body as part of the breakdown of elements of red blood cells. This can cause a non-dangerous yellowing of the skin and whites of the eyes.

Atazanavir capsules are taken once a day with a small boosting dose of another drug called ritonavir (Norvir), and should be taken with other antiretroviral drugs. Recommended dosing in children is:

• 15kg to less than 20kg: Reyataz 150mg + 100mg ritonavir

• 20kg to less than 40kg: Reyataz 200mg + 100mg ritonavir

• 40kg and over: Reyataz 300mg + 100mg ritonavir.