Early HIV Treatment Led To Life Expectancy Gains Valued At $80 Billion For People Infected In 1996–2009

Romley, John A.; Juday, Timothy; Solomon, Matthew D.; Seekins, Daniel; Brookmeyer, Ronald; Goldman, Dana P.

doi:10.1377/hlthaff.2013.0623

Cited by 30 publications

(29 citation statements)

References 36 publications

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“…The main deterrents of widespread use of community HIV screening algorithms to detect AHI appear to be the elevated costs, need for venipuncture, concerns about turnaround time, and lack of laboratory capacity [6,[17][18][19]. Absence of point-of-care (POC) tests that reliably detect AHI may be the major cost-contributing factor, as AHI screening strategies in community-based settings frequently require second visits or alternative approaches to inform clients of their test results.…”

mentioning

confidence: 99%

Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

Hoenigl

Graff-Zivin

2015

Clin Infect Dis.

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Background. In nonhealthcare settings, widespread screening for acute human immunodeficiency virus (HIV) infection (AHI) is limited by cost and decision algorithms to better prioritize use of resources. Comparative cost analyses for available strategies are lacking.Methods. To determine cost-effectiveness of community-based testing strategies, we evaluated annual costs of 3 algorithms that detect AHI based on HIV nucleic acid amplification testing (EarlyTest algorithm) or on HIV p24 antigen (Ag) detection via Architect (Architect algorithm) or Determine (Determine algorithm) as well as 1 algorithm that relies on HIV antibody testing alone (Antibody algorithm). The cost model used data on men who have sex with men (MSM) undergoing community-based AHI screening in San Diego, California. Incremental cost-effectiveness ratios (ICERs) per diagnosis of AHI were calculated for programs with HIV prevalence rates between 0.1% and 2.9%.Results. Among MSM in San Diego, EarlyTest was cost-savings (ie, ICERs per AHI diagnosis less than $13.000) when compared with the 3 other algorithms. Cost analyses relative to regional HIV prevalence showed that EarlyTest was cost-effective (ie, ICERs less than $69.547) for similar populations of MSM with an HIV prevalence rate >0.4%; Architect was the second best alternative for HIV prevalence rates >0.6%.Conclusions. Identification of AHI by the dual EarlyTest screening algorithm is likely to be cost-effective not only among at-risk MSM in San Diego but also among similar populations of MSM with HIV prevalence rates >0.4%.

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mentioning

confidence: 99%

Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

Hoenigl

Graff-Zivin

2015

Clin Infect Dis.

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“…37 Similarly, Romley et al assessed the impact of earlier initiation of combination antiretroviral therapy in the course of HIV (compared to later initiation), and found those who initiated treatment early had life expectancy gains between 6 and 9 years, depending on the CD4 count upon treatment initiation. 38 These articles, along with our results, highlight the clinical value of novel interventions that have the potential to extend life for chronic disease.…”

Section: Discussionmentioning

confidence: 71%

Estimated Lifetime Economic Burden of Type 1 Diabetes

Sussman¹,

Benner²,

Haller

et al. 2020

Diabetes Technology & Therapeutics

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Background: The financial strain of type 1 diabetes on the United States health care system, patients, and employers underscores the importance of developing novel treatments for the disease. This study estimated the lifetime economic burden attributable to type 1 diabetes in the United States. Methods: A patient-level, Markov state/transition simulation model was developed to compare cumulative societal costs among patients with and without type 1 diabetes. For each patient type, 1 prevalent and 10 incident cohorts were constructed and followed annually over a lifetime horizon. The 1 prevalent cohort with type 1 diabetes entered in the first year of the model and at the current age of each patient, whereas the 10 incident cohorts entered in each of 10 subsequent years and at the age of diagnosis of each patient. Patients were assigned age-specific annual medical expenditures and lost wages. Model outputs included the total cumulative medical and lost productivity costs attributable to type 1 diabetes, defined as the difference in costs between patients with and without type 1 diabetes. Results: The model consisted of 1,630,317 patients with type 1 diabetes and an equal number of patients without type 1 diabetes. The difference in lifetime costs was $813 billion (95% confidence interval: $682-$1037 billion), representing a high burden of illness compared with patients without type 1 diabetes. Sensitivity analyses demonstrated robustness in model results. Conclusions: Our findings suggest significant investment in research and development of novel treatments for type 1 diabetes is justified, given the high burden of illness associated with the disease.

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“…HIV is currently effectively managed with cART, often with one pill daily, which results in suppressed viral replication, improved measures of immune function and improved life expectancy[76–79]. However it still remains desirable to develop a cure for HIV as even on cART, life expectancy for HIV infected patients is not completely normalized[80], comorbidities and accelerated rates of disease normally associated with ageing persist[81, 82], and the risk of transmission of HIV in the setting of detectable viral loads [82].…”

Section: Discussionmentioning

confidence: 99%

Increasing procaspase 8 expression using repurposed drugs to induce HIV infected cell death in ex vivo patient cells

et al. 2017

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HIV persists because a reservoir of latently infected CD4 T cells do not express viral proteins and are indistinguishable from uninfected cells. One approach to HIV cure suggests that reactivating HIV will activate cytotoxic pathways; yet when tested in vivo, reactivating cells do not die sufficiently to reduce cell-associated HIV DNA levels. We recently showed that following reactivation from latency, HIV infected cells generate the HIV specific cytotoxic protein Casp8p41 which is produced by HIV protease cleaving procaspase 8. However, cell death is prevented, possibly due to low procaspase 8 expression. Here, we tested whether increasing procaspase 8 levels in CD4 T cells will produce more Casp8p41 following HIV reactivation, causing more reactivated cells to die. Screening 1277 FDA approved drugs identified 168 that increased procaspase 8 expression by at least 1.7-fold. Of these 30 were tested for anti-HIV effects in an acute HIVIIIb infection model, and 9 drugs at physiologic relevant levels significantly reduced cell-associated HIV DNA. Primary CD4 T cells from ART suppressed HIV patients were treated with one of these 9 drugs and reactivated with αCD3/αCD28. Four drugs significantly increased Casp8p41 levels following HIV reactivation, and decreased total cell associated HIV DNA levels (flurbiprofen: p = 0.014; doxycycline: p = 0.044; indomethacin: p = 0.025; bezafibrate: P = 0.018) without effecting the viability of uninfected cells. Thus procaspase 8 levels can be increased pharmacologically and, in the context of HIV reactivation, increase Casp8p41 causing death of reactivating cells and decreased HIV DNA levels. Future studies will be required to define the clinical utility of this or similar approaches.

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Early HIV Treatment Led To Life Expectancy Gains Valued At $80 Billion For People Infected In 1996–2009

Cited by 30 publications

References 36 publications

Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

Estimated Lifetime Economic Burden of Type 1 Diabetes

Increasing procaspase 8 expression using repurposed drugs to induce HIV infected cell death in ex vivo patient cells

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