PMID- 21317689
OWN - NLM
STAT- MEDLINE
DCOM- 20120118
LR  - 20131121
IS  - 1537-4521 (Electronic)
IS  - 0148-5717 (Linking)
VI  - 38
IP  - 5
DP  - 2011 May
TI  - 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.
PG  - 401-9
LID - 10.1097/OLQ.0b013e31820b8bc8 [doi]
AB  - 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 ( approximately US $1200 per 
      LYG) of ART provision in South Africa. RESULTS: For an ART eligibility criteria 
      of CD4 count <200 cells/muL and the cheapest internationally available aciclovir 
      (US $0.026 per day for 2 x 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/muL. Both 
      these projections compare favorably with the estimated cost-effectiveness of ART 
      in South Africa ( approximately 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.
FAU - Vickerman, Peter
AU  - Vickerman P
AD  - Department of Global Health and Development, London School of Hygiene and 
      Tropical Medicine, London, United Kingdom. peter.vickerman@lshtm.ac.uk
FAU - Devine, Angela
AU  - Devine A
FAU - Foss, Anna M
AU  - Foss AM
FAU - Delany-Moretlwe, Sinead
AU  - Delany-Moretlwe S
FAU - Mayaud, Philippe
AU  - Mayaud P
FAU - Meyer-Rath, Gesine
AU  - Meyer-Rath G
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Sex Transm Dis
JT  - Sexually transmitted diseases
JID - 7705941
RN  - 0 (Antiviral Agents)
RN  - X4HES1O11F (Acyclovir)
SB  - IM
MH  - Acyclovir/administration & dosage/*economics/therapeutic use
MH  - Adolescent
MH  - Antiviral Agents/administration & dosage/*economics/therapeutic use
MH  - Cost-Benefit Analysis
MH  - Disease Progression
MH  - Female
MH  - HIV Infections/*complications/physiopathology/*prevention & control
MH  - Herpes Genitalis/complications/*drug therapy/epidemiology
MH  - Herpesvirus 2, Human/*drug effects
MH  - Humans
MH  - Markov Chains
MH  - South Africa
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2011/02/15 06:00
MHDA- 2012/01/19 06:00
CRDT- 2011/02/15 06:00
PHST- 2011/02/15 06:00 [entrez]
PHST- 2011/02/15 06:00 [pubmed]
PHST- 2012/01/19 06:00 [medline]
AID - 10.1097/OLQ.0b013e31820b8bc8 [doi]
PST - ppublish
SO  - Sex Transm Dis. 2011 May;38(5):401-9. doi: 10.1097/OLQ.0b013e31820b8bc8.