Shots - Health Blog
Tue July 19, 2011
HIV Treatment In Africa Brings Near-Normal Lifespan
Lately the good news about HIV/AIDS just keeps rolling in.
Last week two studies demonstrated that a daily antiviral pill protects sexually active men and women from getting infected. Now researchers are showing that the life expectancy of already-infected African patients getting HIV treatment almost matches that of their uninfected countrymen.
"This is the first study that has looked at how long those people can plan to live," study author Edward Mills told Shots. "And we've found very, very positive results."
Actuarial analysis (the kind life insurance companies do to gauge the remaining lifespan of someone at a given age and gender in a given society) reveals that more than 22,000 Ugandans on HIV treatment can expect to live almost as long as those who don't carry the virus. The average life expectancy at birth in Uganda is 55 years.
This is much better than the most optimistic experts dared to hope when antiviral cocktails were first rolled out in the poorest countries less than a decade ago.
"No one really foresaw how effective these drugs would be, and how many people could be treated late in infection and still have their immune function largely restored," says Dr. Deborah Cotton of Boston University School of Medicine, who was not involved in the research. "We knew it was good. It turns out to be great."
Consider this: Typically, Ugandans with HIV infection don't start on triple-drug antivirals until the level of their CD4 cells has fallen to 150 cells per cubic milliliter of blood. A normal CD4 count can vary from 500 to 1,500. The World Health Organization recommends starting antiretroviral therapy when CD4s are below 350.
Translation: Ugandans with HIV, like most in sub-Saharan Africa, don't get antivirals until their immune systems are devastated.
So one implication of the new analysis, Cotton says, is "we can do even better, and we will do better if we treat people earlier."
But not everybody in Uganda benefits equally from treatment. Far fewer men are getting treated. "About 25 percent of antiretroviral drug patients are men, whereas it should be about 40 percent, from the number of men who are testing positive," Mills says.
Focus groups that Mills and his colleagues have run show that "men are ashamed about what they may or may not have done, and are not accessing care," he says. "They may go to traditional healers or try to self-treat with aspirin. Or they reject the diagnosis of HIV."
As a result, men get into HIV treatment even later than women do, and they're more likely to drop out. "So men can expect to live about two-thirds as long as women do," Mills says.
Adolescents are another problem group. They have the same death rates as the oldest Ugandans on HIV treatment. That's probably because they got infected at birth, and spent most of their childhood without treatment. Experts hope this problem will abate as more children get on antivirals early and stay on them – though Mills says there's a lot of work to be done to design and deliver good HIV care to children.
Still, the remarkable thing about Uganda's experience is that most patients do so well despite all the shortcomings in delivery of HIV treatment there.
Cotton thinks that news like this will reinvigorate the global AIDS community in its drive to get more people into treatment in developing countries, despite tough times for funding.
"I think this will be a shot in the arm," she says. "This has always been a motivated group of people – both patients and providers. But I think for many of us who've spent our lives working in HIV, we're very committed to seeing the end of this disease in our lifetime. And some of us are getting older."
The new motivation comes not just from the longevity study, of course. That's just the icing on the cake. Underneath are several newly baked layers of research findings conclusively showing that antiviral drugs can prevent uninfected people from getting HIV, and early treatment of HIV-positive people can sharply reduce their risk of infecting someone else.
As the buzz at the Rome meeting this week goes: "Treatment is prevention."