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  • Impact of Reaching U.S. Goals for HIV Treatment Would Be Massive and Cost-Effective

    09/28/2017

    Study suggests major clinical benefits, excellent economic value from achieving national targets

    If the U.S. were to reach targets for HIV testing and treatment by 2020, the impact, measured by lives saved and new infections prevented over the next 20 years, would be massive. According to a new study in The Journal of Infectious Diseases, achieving these goals would avert nearly 200,000 deaths, prevent approximately 280,000 new HIV infections, and save more than 2 million years of life in the U.S. over the following two decades. The additional federal spending required would also be affordable and cost-effective, the research suggests.

    "This analysis demonstrates that we have it in our power, and even within our economic reach, to stop the HIV/AIDS epidemic in the United States," said study author Rochelle P. Walensky, MD, MPH, of Massachusetts General Hospital and Harvard Medical School. "The strategy to once-and-for-all tackle the HIV epidemic in the U.S. is both of excellent economic value and affordable, based on our analysis of the number of dollars that we need to reach these goals." 

    The researchers used a mathematical simulation to project the long-term clinical outcomes, costs, and cost-effectiveness of reaching nationwide targets for the U.S. response to HIV by 2020, as set out in the U.S. National HIV/AIDS Strategy. Released by the federal government in 2010 and revised in 2015, the strategy's goals include a target of 90 percent for the proportion of people in the U.S. with HIV who know they are infected. Among those diagnosed with HIV infection, the strategy also calls for at least 80 percent to have a viral load that is suppressed by antiretroviral drugs. These goals, if achieved, would mean that 72 percent of people living with HIV have fully suppressed virus, much higher than the current U.S. estimate of 49 percent.

    The study's findings suggest that reaching these targets by 2020-and sustaining them into the future-would yield major clinical and economic benefits over the next 20 years. The impact would be particularly striking and extraordinarily cost-effective, the analysis found, in black men who have sex with men, a population hard hit by the HIV epidemic who account for more HIV diagnoses in the U.S. than any other group, according to the Centers for Disease Control and Prevention. Achieving these goals, however, will require new, culturally grounded, and non-stigmatizing strategies that address barriers that have to date limited access to HIV testing and treatment in this key population and others, the researchers noted.

    To cover the costs of reaching the treatment goals outlined in the National HIV/AIDS Strategy and maintaining them, the study finds that the federal HIV budget would need to grow 23 percent-or by approximately 5 percent per year-over the next 20 years. Seventy-five percent of the additional spending would be for antiretroviral drugs, the analysis found, which now cost approximately $40,000 per person, per year. "If drug costs could be reduced by just a third, you could use just those savings alone to pay for this strategy," said the study's first author, Ethan D. Borre of the Medical Practice Evaluation Center at Massachusetts General Hospital.

    In a related editorial commentary, Adaora A. Adimora, MD, MPH, of the University of North Carolina at Chapel Hill, noted that gains made to date in controlling HIV in the U.S. are fragile and could easily be reversed if access to quality care is lost.

    "Conversely, increasing investment in health care to achieve the major National HIV/AIDS Strategy treatment targets would decrease human suffering and is clearly cost-effective," wrote Dr. Adimora, who was not involved with the study. "Ending the U.S. HIV epidemic will require political will at the state and federal levels to ensure good health care for everyone in the nation-and an understanding that what benefits the most vulnerable in society ultimately benefits us all."

    Fast Facts

    • Reaching national targets for HIV treatment by 2020 would have massive clinical and economic benefits in the U.S. over the following two decades, a new study suggests.
    • Nearly 200,000 deaths would be averted, about 280,000 new HIV infections would be prevented, and more than 2 million years of life would be saved in the U.S., researchers projected.
    • Additional federal spending would be needed to achieve HIV testing and treatment goals in the U.S., but this spending would be affordable and cost-effective.

    Editor's Note: The study was funded by the National Institutes of Health and the Steve and Deborah Gorlin Massachusetts General Hospital Research Scholars Award. The study authors' and editorial commentary author's affiliations, acknowledgments, and disclosures of financial support and potential conflicts of interests, if any, are available in the study and the commentary.    

    The Clinical and Economic Impact of Attaining National HIV/AIDS Strategy Treatment Targets in the United States

    https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jix349

    Implementing National HIV/AIDS Strategy 2015 Treatment Targets Is Cost-effective and Would Save Lives: What Other Evidence Do We Need?

    https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jix351

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    Published continuously since 1904,The Journal of Infectious Diseases is the premier global journal for original research on infectious diseases. The editors welcome major articles and brief reports describing research results on microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. The journal is an official publication of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing nearly 10,000 physicians and scientists who specialize in infectious diseases. For more information, visitwww.idsociety.org. Follow IDSA onFacebook andTwitter.

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