An
HIV treatment regimen already widely used in North America and Europe would
likely increase the life expectancy of people living with HIV in India by
nearly three years and reduce the number of new HIV infections by 23 percent
with minimal impact on the country's HIV/AIDS budget. The findings from an
international team of investigators have been published online in the Journal
of the International AIDS Society.
"This study is the
first to show that, in India, changing current therapy to a dolutegravir-based
regimen would be safer, save lives and prevent new infections -- all without
increasing the cost of care," said lead author Amy Zheng of the Massachusetts
General Hospital (MGH) Medical Practice Evaluation Center in Boston.
Dolutegravir, developed
by the HIV specialist company ViiV Healthcare, has been shown to have fewer
side effects and be less likely to induce drug resistance than other currently
available HIV drugs. It is currently recommended in North America and Europe as
initial therapy for newly infected patients and is available in multiple
African countries. A generic version has only recently become available in
India.
The researchers used a
widely-published mathematical model to project the survival and economic
outcomes of adopting a dolutegravir-based regimen as first-line therapy by the
Indian health system. Based on cost estimates from the Clinton Health Access
Initiative, the analysis assumed the annual cost of the new drug would be $102
U.S. per patient, which is slightly higher than the $98 annual cost of current
therapy in India. The team assessed the impact of a dolutegravir-based regimen
on life expectancy, the number of new HIV transmissions, HIV care costs and the
national Indian HIV budget over 2- and 5-year time horizons.
The results indicated
that the new regimen would extend the life expectancy of people living with HIV
by 2.8 years and prevent 13,000 new HIV infections over 5 years. Importantly,
using dolutegravir as first-line treatment is likely to be cost-effective in 2
years and cost-saving over 5 years -- that is, the clinical and public health
benefits would be realized at no additional cost to the national government,
compared with the costs of the current regimens. Adoption of dolutegravir-based
treatment would likely reduce the number of patients who require a switch to
more costly and less effective second- and third-line HIV therapies.
Study author
Nagalingeswaran Kumarasamy, MD, chief medical officer of the Y.R. Gaitonde
Centre for AIDS Research and Education in Chennai, India, says, "Given the
size and scope of the HIV epidemic in India, making a dolutegravir-based
regimen first-line therapy through the National AIDS Control Organization will
provide tremendous benefit to our patients and to India as a whole."
In late 2017, two
India-based pharmaceutical companies agreed to provide a generic,
dolutegravir-based combination drug to several African countries for $75 per
patient per year, a cost even lower than that of current HIV therapy in India.
However, in spite of these new advances in HIV therapy in other nations,
generic dolutegravir remains out of reach in India -- both because of its
current costs in that country and because it is not yet the standard therapy --
a country in which more than 2 million people live with HIV, the world's third
largest population with HIV.
"With India being
the world's leading producer of generic HIV therapy, it only makes sense for
the tremendous benefits of these therapies to become available to people with
HIV in India," added study senior author Kenneth A. Freedberg, MD, MSc, of
the MGH Medical Practice Evaluation Center, a professor of Medicine at Harvard
Medical School.
Source: https://www.sciencedaily.com/releases/2018/04/180430131843.htm
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