title: The cost-effectiveness of herpes simplex virus-2 suppressive therapy with daily aciclovir for delaying HIV disease progression among HIV-1-infected women in South Africa.
abstract: BACKGROUND
  The Partners in Prevention HSV/HIV transmission trial (Partners HSV/HIV Transmission Study) showed that herpes simplex virus-2 (HSV-2) suppressive therapy with daily aciclovir could decrease HIV disease progression amongst HIV-1/HSV-2 coinfected individuals. The cost-effectiveness of daily aciclovir for delaying HIV-1 disease progression in women not eligible for antiretroviral therapy (ART) is estimated.
  
  
  METHODS
  Resource use/cost data for delivering daily aciclovir at a primary health care HIV clinic were collected in Johannesburg. Effectiveness estimates were obtained from the Partners HSV/HIV Transmission Study trial and epidemiologic data from South Africa. A Markov model simulated the cost-effectiveness of daily aciclovir on HIV-1 disease progression in ART-naive women. Therapy was given to all HIV-1-infected women. Cost-effectiveness was compared against cost per life-year gained (∼US $1200 per LYG) of ART provision in South Africa.
  
  
  RESULTS
  For an ART eligibility criteria of CD4 count <200 cells/μL and the cheapest internationally available aciclovir (US $0.026 per day for 2 × 400 mg aciclovir), the median cost per LYG is US $1023 (95% confidence interval [CI]: 537-2842), whereas it decreases to US $737 (95% CI: 373-2489) if the ART eligibility criteria is CD4 count <350 cells/μL. Both these projections compare favorably with the estimated cost-effectiveness of ART in South Africa (∼US $1200 per LYG). The cost per LYG increases dramatically for the current aciclovir cost in South Africa (US $0.14 per day), if salary costs are higher and if HSV-2 prevalence amongst HIV-1-infected women are lower. Projections suggest HSV-2 suppressive therapy could dramatically increase the proportion of women initiating ART.
  
  
  CONCLUSIONS
  HSV-2 suppressive therapy could be an affordable strategy for reducing HIV-1 disease progression and retaining women in care before ART initiation, but cheaply available aciclovir is needed.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom. peter.vickerman@lshtm.ac.uk
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
authors.forename: Angela
authors.initials: A
authors.lastname: Devine
authors.forename: Anna M
authors.initials: AM
authors.lastname: Foss
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.forename: Philippe
authors.initials: P
authors.lastname: Mayaud
authors.forename: Gesine
authors.initials: G
authors.lastname: Meyer-Rath
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D000293:Adolescent; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control*; D006558:Herpes Genitalis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D018258:Herpesvirus 2, Human / Q000187:drug effects*; D006801:Humans; D008390:Markov Chains; D013019:South Africa; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir