Delay in AIDS drug use in South Africa costly

NEW YORK (Reuters Health) - Researchers from Harvard School of Public Health in Boston estimate that between 2000 and 2005 more than 330,000 lives were lost because a "feasible and timely" AIDS drug treatment program was not implemented in South Africa.

By not implementing a mother-to-child transmission HIV prevention program during the same 5-year period, an estimated 35,000 infants were born with HIV.

Dr. Pride Chigwedere and colleagues describe their analyses that generated these estimates in a Perspectives article published online in the Journal of Acquired Immune Deficiency Syndromes.

By way of background, at the peak of the South Africa AIDS epidemic, they explain, "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 (an AIDS drug) and grants from the Global Fund."

To estimate lost benefits due to these decisions, the investigators compared the actual number of South Africans who received drugs for treatment of HIV infection or for prevention of mother-to-child HIV transmission between 2000 and 2005 with what was reasonably feasible in the country during that period. They then multiplied the differences by the average "life-years" conferred by antiretroviral therapy for African patients with AIDS or the efficacy of antiretroviral treatment in preventing mother-to-child transmission.

For comparison, the researchers used data from Botswana and Namibia, neighboring countries facing a similar burden of HIV/AIDS and with similar resources per capita. In contrast to South Africa, Botswana and Namibia began a program for the prevention of mother-to-child transmission in 1999 and a national AIDS treatment program in 2001.

The investigators estimate that the total lost benefits of not using antiretroviral drugs between 2000 and 2005 amount to at least 3.8 million "person-years."

"Access to appropriate public health practice is often determined by a small number of political leaders," they note in their report.

"In the case of South Africa, many lives were lost because of a failure to accept the use of available antiretrovirals to prevent and treat HIV/AIDS in a timely manner," they conclude.

SOURCE: Journal of Acquired Immune Deficiency Syndromes, 2008.