title: The survival benefits of antiretroviral therapy in South Africa.
abstract: BACKGROUND
  We sought to quantify the survival benefits attributable to antiretroviral therapy (ART) in South Africa since 2004.
  
  
  METHODS
  We used the Cost-Effectiveness of Preventing AIDS Complications-International model (CEPAC) to simulate 8 cohorts of human immunodeficiency virus (HIV)-infected patients initiating ART each year during 2004-2011. Model inputs included cohort-specific mean CD4(+) T-cell count at ART initiation (112-178 cells/µL), 24-week ART suppressive efficacy (78%), second-line ART availability (2.4% of ART recipients), and cohort-specific 36-month retention rate (55%-71%). CEPAC simulated survival twice for each cohort, once with and once without ART. The sum of the products of per capita survival differences and the total numbers of persons initiating ART for each cohort yielded the total survival benefits.
  
  
  RESULTS
  Lifetime per capita survival benefits ranged from 9.3 to 10.2 life-years across the 8 cohorts. Total estimated population lifetime survival benefit for all persons starting ART during 2004-2011 was 21.7 million life-years, of which 2.8 million life-years (12.7%) had been realized by December 2012. By 2030, benefits reached 17.9 million life-years under current policies, 21.7 million life-years with universal second-line ART, 23.3 million life-years with increased linkage to care of eligible untreated patients, and 28.0 million life-years with both linkage to care and universal second-line ART.
  
  
  CONCLUSIONS
  We found dramatic past and potential future survival benefits attributable to ART, justifying international support of ART rollout in South Africa.
authors.affiliation: Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Texas.
authors.forename: Michael D
authors.initials: MD
authors.lastname: April
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Bethany K
authors.initials: BK
authors.lastname: Berkowitz
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; South Africa; highly active antiretroviral therapy