Background:  Our objective was to estimate the cumulative clinical benefit of AIDS-related opportunistic infection prophylaxis and highly active antiretroviral therapy (HAART) in the United States.

Methods:  We used published estimates to derive the number of newly diagnosed adult AIDS patients receiving care in the United States from l989 to 2002.  We considered 5 life-prolonging interventions and the years each was recommended as standard of care:  PCP and MAC prophylaxis (1989 and 1993), HAART (1996), HAART-2 (2 sequential effective regimens, 1998), and HAART-3 (3 sequential effective regimens, 2000).  To ensure conservative estimates, we included only newly diagnosed AIDS patients in care and assumed they received only the care that was standard in the year of diagnosis.  Per person survival benefits of each intervention were estimated using the cost-effectiveness of preventing AIDS complications (CEPAC) model, a widely published computer simulation of HIV disease.  Sensitivity analyses included varying the number of AIDS patients in care (63% in the base case), adding the benefits of zidovudine (AZT) for the prevention of mother-to-child transmission (1994), and varying HAART efficacy.

Results:

†Associated with prostate cancer therapy = 1 to 11; breast cancer therapy = 3.6 to 11; thrombolytics during a myocardial infarction = 15; and CABG = 1 to 14.

AZT for prevention of mother-to-child transmission averted approximately 2860 infant infections, adding another 186,790 years of life.  Had all pregnant women received AZT, the survival benefit would have increased to 277,150 years.  Had all diagnosed AIDS patients been in care, total survival benefits would have increased to 2,828,930 years.  Improving viral load suppression rates of all HAART regimens to 90% at 48 weeks would have increased total survival benefits to 2,830,460 years.

Conclusions:  Progress in HIV care has saved nearly 2 million years of life in the United States since 1989.  The per person benefits far exceed those conferred by treatment of other chronic diseases and highlight the importance of HIV diagnosis, linkage to effective care, and continued research in HIV therapeutics.

Keywords: Survival; HAART; Prophylaxis