As numerous studies conclude that early initiation of antiretroviral therapy reduces illness and prolongs lives, government programmes have responded with doubts of the financial sustainability of a programme that starts treatment early. The tide might soon start changing.
A US-South Africa study found that starting ART at a CD4 count of 350 would be a cost effective treatment - the additional cost offset by the reduced illness and death. The conclusions are based on a computer-based model of how many people are infected, how the disease progresses and what it costs to the South African health services.
The study by Rochelle Walensky and others was published in the August 4, 2009 edition of Annals of Internal Medicine. Early initiation is already the practice in the US and Europe and with many private doctors in developing countries.
And some second-line drugs are getting cheaper. The Clinton HIV/AIDS Initiative has announced a subsidised package of second-line antiretroviral drugs for developing countries. Tenofovir, lamivudine (3TC), atazanavir and a boosting dose of ritonavir will be available at $475 a year (compared to $590/year for the previous cheapest option for second-line treatment, lopinavir/ritonavir plus tenofovir/3TC, currently offered to qualifying developing countries, also by the Clinton Initiative). In 2010, the Indian generic drug maker Matrix will offer a combination package of these drugs for $425/year.
(Source:Keith Alcorn, www.aidsmap.com)
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