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1 July 2006

Volume 194, Number 1
The Journal of Infectious Diseases 2006;194:11–19
© 2006 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2006/19401-0004$15.00
DOI: 10.1086/505147
MAJOR ARTICLE

The Survival Benefits of AIDS Treatment in the United States

Rochelle P. Walensky,1,2,5

A. David Paltiel,6

Elena Losina,4

Lauren M. Mercincavage,1

Bruce R. Schackman,7

Paul E. Sax,5

Milton C. Weinstein,3 and

Kenneth A. Freedberg1,2,3,4

1Divisions of Infectious Disease and General Medicine, Department of Medicine, Massachusetts General Hospital, and 2Center for AIDS Research, Harvard Medical School, and 3Department of Health Policy and Management, Harvard School of Public Health, 4Departments of Biostatistics and Epidemiology, Boston University School of Public Health, and 5Division of Infectious Disease, Brigham and Women’s Hospital, Boston; 6Division of Health Policy and Administration, Yale School of Medicine, New Haven, Connecticut; 7Department of Public Health, Weill Medical College of Cornell University, New York, New York

Background.As widespread adoption of potent combination antiretroviral therapy (ART) reaches its tenth year, our objective was to quantify the cumulative survival benefits of acquired immunodeficiency syndrome (AIDS) care in the United States.

Methods.We defined eras corresponding to advances in standards of human immunodeficiency virus (HIV) disease care, including opportunistic infection prophylaxis, treatment with ART, and the prevention of mother‐to‐child transmission (pMTCT) of HIV. Per‐person survival benefits for each era were determined using a mathematical simulation model. Published estimates provided the number of adult patients with new diagnoses of AIDS who were receiving care in the United States from 1989 to 2003.

Results.Compared with survival associated with untreated HIV disease, per‐person survival increased 0.26 years with Pneumocystis jiroveci pneumonia prophylaxis alone. Four eras of increasingly effective ART in addition to prophylaxis resulted in per‐person survival increases of 7.81, 11.05, 11.57, and 13.33 years, compared with the absence of treatment. Treatment for patients with AIDS in care in the United States since 1989 yielded a total survival benefit of 2.8 million years. pMTCT averted nearly 2900 infant infections, equivalent to 137,000 additional years of survival benefit.

Conclusions.At least 3.0 million years of life have been saved in the United States as a direct result of care of patients with AIDS, highlighting the significant advances made in HIV disease treatment.

Received 25 October 2005; accepted 2 March 2006; electronically published 1 June 2006.

  • (See the editorial commentary by Vermund, on pages 1–5.)

Reprints or correspondence: Dr. Rochelle P. Walensky, Div. of General Medicine, Massachusetts General Hospital, 50 Staniford St., 9th Fl., Boston, MA 02114 ().

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  • Presented in part: 12th Conference on Retroviruses and Opportunistic Infections, Boston, MA, 22–25 February 2005 (abstract 143LB).

    Potential conflicts of interest: P.E.S. receives consultancy funding, teaching honoraria, and grant support from the following sources: Abbott, Boehringer Ingelheim, Bristol‐Myers Squibb, Merck, Gilead, Pfizer, and GlaxoSmithKline. All other authors report no potential conflicts of interest.

    Financial support: National Institute of Allergy and Infectious Diseases (grants K23AI01794, K24AI062476, K25AI50436, R01AI42006, and P30AI060354); National Institute of Mental Health (grant R01MH65869); National Institute on Drug Abuse (grants K01DA017179 and R01DA015612); US Centers for Disease Control and Prevention (grant S1396‐20/21).

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