Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa.
BACKGROUND
Despite growing international pressure to provide HIV-1 treatment to less-developed countries, potential demographic and epidemiological impacts have yet to be characterised. We modelled the future impact of antiretroviral use in South Africa from 2000 to 2005.


METHODS
We produced a population projection model that assumed zero antiretroviral use to estimate the future demographic impacts of the HIV-1 epidemic. We also constructed four antiretroviral-adjusted scenarios to estimate the potential effect of antiretroviral use. We modelled total drug cost, cost per life-year gained, and the proportion of per-person health-care expenditure required to finance antiretroviral treatment in each scenario.


RESULTS
With no antiretroviral use between 2000 and 2005, there will be about 276,000 cumulative HIV-1-positive births, 2,302,000 cumulative new AIDS cases, and the life expectancy at birth will be 46.6 years by 2005. By contrast, 110,000 HIV-1-positive births could be prevented by short-course antiretroviral prophylaxis, as well as a decline of up to 1 year of life expectancy. The direct drug costs of universal coverage for this intervention would be US$54 million--less than 0.001% of the per-person health-care expenditure. In comparison, triple-combination treatment for 25% of the HIV-1-positive population could prevent a 3.1-year decline in life expectancy and more than 430,000 incident AIDS cases. The drug costs of this intervention would, however, be more than $19 billion at present prices, and would require 12.5% of the country's per-person health-care expenditure.


CONCLUSIONS
Although there are barriers to widespread HIV-1 treatment, limited use of antiretrovirals could have an immediate and substantial impact on South Africa's AIDS epidemic.
Wood
E
E
British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada.
Braitstein
P
P
Montaner
J S
JS
Schechter
M T
MT
Tyndall
M W
MW
O'Shaughnessy
M V
MV
Hogg
R S
RS
D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D003710:Demography; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008017:Life Expectancy; D015993:Life Tables; D008297:Male; D008962:Models, Theoretical; D011247:Pregnancy; D015995:Prevalence
D019380:Anti-HIV Agents