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PLoS One. 2014 Nov 14;9(11):e113031. doi: 10.1371/journal.pone.0113031. eCollection 2014.

HIV cure strategies: how good must they be to improve on current antiretroviral therapy?

Author information

1
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America.
2
Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
3
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America; Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America.
4
Yale School of Public Health, New Haven, Connecticut, United States of America.
5
Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America.
6
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
7
Division of Infectious Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
8
Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America; Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America; Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America.

Abstract

BACKGROUND:

We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART).

METHODS:

We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY.

RESULTS:

For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving.

CONCLUSIONS:

Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.

PMID:
25397616
PMCID:
PMC4232561
DOI:
10.1371/journal.pone.0113031
[Indexed for MEDLINE]
Free PMC Article
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