HIV This Week

Chigwedere P, Seage GR 3rd, Gruskin S, Lee TH, Essex M. Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa. J Acquir Immune Defic Syndr. 2008 Oct 16. [Epub ahead of print]

South Africa is one of the countries most severely affected by HIV. At the peak of the epidemic, the government, going against consensus scientific opinion, argued that HIV was not the cause of AIDS and that antiretroviral drugs were not useful for patients and declined to accept freely donated nevirapine and grants from the Global Fund to fight AIDS, Tuberculosis and Malaria. Using modelling, Chigwedere and colleagues compared the number of persons who received antiretroviral drugs for treatment and prevention of mother-to-child HIV transmission between 2000 and 2005 with an alternative of what was reasonably feasible in the country during that period. More than 330,000 lives or approximately 2.2 million person-years were lost because a feasible and timely antiretroviral drug treatment programme was not implemented in South Africa. Thirty-five thousand babies were born with HIV, resulting in 1.6 million person-years lost by not implementing a mother-to-child transmission prophylaxis program using nevirapine. The total lost benefits of antiretroviral drugs are at least 3.8 million person-years for the period 2000-2005.

Editors’ notes: This modelling did not consider the potential lost benefits from the possible impact that treatment could have had on HIV prevention via secondary transmission. Nonetheless, it stands as telling testimony of the burden that must be borne by many for the inaction of a few. The ‘counterfactual’ (what would have happened had a different course of action been taken) is something for us all to consider, for South Africans, for us as committed individuals, and for us as a global health community challenged to facilitate worldwide the best way forward in responding to HIV.

That was HIV this week, signing off.