AIDS drugs, tests are economical in poor countries

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Antiretroviral drugs added almost a year to patients' lives in Ivory Coast compared with antibiotics alone, according to researchers from there and the Harvard School of Public Health in Boston. The $620 annual cost per person of the combination treatment was less than the per-capita gross domestic product of $708 in the country, located on Africa's western coast. „When we included the costs, and looked at gross domestic product in the Ivory Coast, we found not only that these interventions were effective, but by international standards they were considered highly cost-effective,” said Kenneth Freedberg, senior researcher on the study, which was published today in the New England Journal of Medicine. The results show that HIV drugs, antibiotics and tests that help determine when treatment should start are worth the expense in countries where the per-capita GDP is among the lowest levels, Freedberg said. The US is spending $3.2 billion for the fiscal year ending this month to provide prevention and treatment in the poorest countries under the President's Emergency Program for AIDS Relief. „This study shows that these US resources are very well spent, and that programs like that should be continued and should be expanded,” said Freedberg, an associate professor of medicine at Harvard.

The World Health Organization's Commission on Macroeconomics and Health has established reasonable-cost standards for extending a life. Medical expenses that come in at less than per-capita GDP per year are considered „very cost-effective.” A therapy that costs less than three times that level is still considered „cost-effective.” Three times per capita GDP in the Ivory Coast is $2,124. Basing treatment decisions on a gauge of white blood cells that indicates the strength of the immune system, called a CD4 test, added almost three more years to a patient's life, on average. The test raised the total cost per person in Ivory Coast to $1,180, still economically worthwhile under the WHO standards, Freedberg said. „This simple blood test, even though it includes added costs, allows you to get the most benefit from the medicines,” he said.

CD4 cells, also known as T-helper cells, support the immune system. As HIV advances in the body, the number of CD4 cells decreases. In the absence of these immune-system defenders, potentially deadly infections such as pneumonia, Kaposi's sarcoma and tuberculosis may take hold. Treatment with drugs can reverse the decline of CD4 cells, allowing the body to stave off infections again. The CD4 test is useful because it tells doctors when the immune system has declined to a point that it will have trouble fighting off the HIV-related infections, and that it's time to start prescribing the medicines, Freedberg said. Without the CD4 test, patients don't get the antiretrovirals until after they get an infection that signals a weakened immune system. In African countries, many patients don't survive the first infection, he said. „We found the therapy works well without the lab tests, but it works much better if you do include the tests,” Freedberg said. „And it's also cost-effective to do the tests in poor countries. That is quite controversial.” (Bloomberg)

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