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So confused about this information
Mar 19, 2006

I'm so confused about this information I found on AidsMeds.com. Can you please spread some light on the matter for me? I thought from Dr. Youn's postings and others on this site that I could realisticly hope for a normaly life span. Listed below is the information I was reading:

Benefits of early HAART may outweigh cardiovascular risks

Last Updated: 2002-12-04 15:39:13 -0400 (Reuters Health)

By Steven Reinberg

NEW YORK (Reuters Health) - Starting highly active antiretroviral therapy (HAART) early increases life expectancy and is a more efficient use of resources than deferring therapy, researchers report.

"HIV therapy is cost-effective for patients who have not yet progressed to AIDS, even when the cholesterol and fat redistribution side effects of therapy are considered," lead author Dr. Bruce R. Schackman from the Weill Medical College of Cornell University, New York, told Reuters Health. "Side effects of HIV therapy do not justify limiting access to early treatment," he added.

Dr. Schackman and colleagues constructed a model to compare starting HAART when patients' CD4 counts were 350 cells per microliter (early therapy) or starting therapy when CD4 counts were 200 cells per microliter (deferred therapy). Patients in both groups had viral loads of 10,000 copies/mL to 30,000 copies/mL.

The researchers collected data from clinical trials, cohort studies, and other published literature, according to their report in the November 25th issue of the Archives of Internal Medicine.

Dr. Schackman's group assumed that HAART would increase cholesterol levels and thereby increase risk of coronary heart disease. Given this assumption, they estimated life expectancy for a 37-year-old patient to be 16.54 years with early treatment compared with 13.73 years with deferred treatment.

Without an increased risk of coronary heart disease, life expectancy was 16.66 years for early therapy compared with 13.80 years for deferred treatment, they report.

They also found early therapy to be more efficient. Compared with no therapy, with or without increased heart disease risk, the cost of early treatment was $13,000 per quality-adjusted life-year.

When the researchers took into account reductions in the quality of life among patients with fat redistribution symptoms, the cost per quality-adjusted life-year ranged from $17,000 to $24,000, they note.

As long as the reduction in quality of life was 70% or less, early therapy afforded a higher quality-adjusted life expectancy compared with deferred treatment, Dr. Schackman's team concluded.

"Cholesterol side effects should be treated with cholesterol-lowering medication in accordance with current guidelines," Dr. Schackman said. "Physicians should evaluate the potential impact of fat redistribution side effects on the quality of life of each of their patients to help determine when is the optimal time to start treatment for that patient," he advised.

These findings are encouraging, Dr. Samuel Bozzette from the University of California San Diego, told Reuters Health. Compared with some other diseases, HIV infection has never been particularly expensive, he said.

"The therapies are so powerful and so clearly life-saving that they are a bargain," Dr. Bozzette pointed out. HAART prevents "expensive complications and dramatically prolongs life."

"This is another piece of evidence that powerful treatments are reasonably priced," he added. It also illustrates that "there is no crisis in the cost of AIDS treatment--there is a crisis in the financing of AIDS treatment."

Arch Intern Med 2002;162:2478-2486.

Response from Dr. Henry

Much of the published data on life expectancy in AIDS patients represents experience with older drug regimens and patient populations. Hard data on outcomes with potent antiretroviral therapy (ART) is limited to 10 years (the time period such therapy has been available). Projections into the future are subject to variability and uncertainty. That being said I am confident that patients who are doing well on potent ART (CD4 count > 350 and undetectable virus) are likely to do well for decades (particularly for those patients with no resistance and who rarely miss a dose). The failure rate per year for patients doing well on a given regimen is generally quite low (2-5%/year range) which predicts a good outcome well into future decades. KH



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