patient- and population-level health consequences of discontinuing antiretroviral therapy in settings with inadequate hiv treatment availability病人和全民健康后果设置中断抗逆转录病毒治疗的艾滋病毒治疗不足的可用性.pdfVIP

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patient- and population-level health consequences of discontinuing antiretroviral therapy in settings with inadequate hiv treatment availability病人和全民健康后果设置中断抗逆转录病毒治疗的艾滋病毒治疗不足的可用性.pdf

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patient- and population-level health consequences of discontinuing antiretroviral therapy in settings with inadequate hiv treatment availability病人和全民健康后果设置中断抗逆转录病毒治疗的艾滋病毒治疗不足的可用性

Kimmel et al. Cost Effectiveness and Resource Allocation 2012, 10:12 /content/10/1/12 RESEARCH Open Access Patient- and population-level health consequences of discontinuing antiretroviral therapy in settings with inadequate HIV treatment availability 1,2,3* 3 5,6 3 3 6 April D Kimmel , Stephen C Resch , Xavier Anglaret , Norman Daniels , Sue J Goldie , Christine Danel , 7 3,4,7 3,4 Angela Y Wong , Kenneth A Freedberg and Milton C Weinstein Abstract Background: In resource-limited settings, HIV budgets are flattening or decreasing. A policy of discontinuing antiretroviral therapy (ART) after HIV treatment failure was modeled to highlight trade-offs among competing policy goals of optimizing individual and population health outcomes. Methods: In settings with two available ART regimens, we assessed two strategies: (1) continue ART after second-line failure (Status Quo) and (2) discontinue ART after second-line failure (Alternative). A computer model simulated outcomes for a single cohort of newly detected, HIV-infected individuals. Projections were fed into a population-level model allowing multiple cohorts to compete for ART with constraints on treatment capacity. In the Alternative strategy, discontinuation of second-line ART occurred upon detection of antiretroviral failure, specified by WHO guidelines. Those discontinuing failed ART experienced an increased risk of AIDS-related mortality compared to those continuing ART. Results: At the population level, the Alternative strategy increased the mean number initiating ART annually by 1,100 individuals (+18.7%) to 6,980 compared