CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

Figure 1: Cumulative discounted lifetime costs from time of infection at age 35 (2012 US dollars) Conclusions: The potential medical cost savings from HIV prevention in the US are substantial given the high cost of HIV disease treatment. 1119 Survival Benefits Attributable to the Brazilian National ART Policy

Paula M. Luz 1 ; Michael P. Girouard 2 ; Beatriz Grinsztejn 1 ; Kenneth Freedberg 2 ;ValdileaVeloso 1 ; Elena Losina 4 ; Claudio Struchiner 1 ; Robert Parker 2 ; David Paltiel 3 ; RochelleWalensky 2 1 Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; 2 Massachusetts General Hospital, Boston, MA, US; 3 Yale School of Public Health, New Haven, CT, US; 4 Brigham and Women’s Hospital, Boston, MA, US Background: In Brazil, universal provision of antiretroviral therapy (ART) has been guaranteed free of charge to patients since 1996. We sought to quantify the survival benefits attributable to this policy. Methods: We used a mathematical model of HIV disease (CEPAC-International) to estimate life expectancy of HIV-infected patients initiating ART between 1997 and 2013 in Brazil. We divided this timeframe into 5 eras, reflecting improvements in virologic and immunologic response to ART and in regimen sequencing over time. Input parameters were from the HIV Clinical Cohort at the Evandro Chagas Clinical Research Institute (Oswaldo Cruz Foundation) and from published Brazilian governmental data. Era-specific mean CD4 count at ART initiation ranged from 134/ μ L (Era 1) to 384/ μ L (Era 5). We included a loss to follow-up rate in each cohort of 10.1/1000 person-years. The 2014-censored and lifetime survival benefit attributable to each era were calculated as the sum of patients initiating ART in each cohort of a given era multiplied by the per-person survival increase attributable to ART in that era compared to pre-ART prophylaxis alone. Results: In total, 556,829 individuals were estimated to have initiated ART in Brazil between 1997 and 2013 (Figure 1). Patients initiating ART in Era 1 had an estimated 2014- censored per-person life expectancy of 6.3 years compared to 2.9 years for pre-ART prophylaxis. Assuming no further improvements in care over time, projected lifetime per- person life expectancy increased from pre-ART (2.9 years) to 11.4, 17.0, 20.6, 23.7, and 25.7 years in Eras 1, 2, 3, 4, and 5, respectively. Total estimated population lifetime survival benefit for all persons starting ART from 1997 to 2013 in Brazil was 9.2 million life-years, with 1.3 million life-years realized as of 2014.

Oral Abstracts

Figure 1. Years of life saved per person in each era produced by model simulations with a mean age at treatment initiation of 37 years (SD, 10 years). Bar width corresponds to the number of patients in each era and total colored area corresponds to lifetime survival benefits. Survival benefits realized as of 2014 are shaded with diagonal lines. Conclusions: Brazil’s national policy of free-of-charge ART access to patients has led to dramatic survival benefits, the vast majority of which have yet to be realized. Earlier HIV diagnosis, increased numbers accessing care, and improvements in ART regimens have all contributed substantially to these benefits.

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CROI 2015