Nav: Home

State-of-the-art HIV drug could curb HIV transmission, improve survival in India

April 30, 2018

An HIV treatment regimen already widely used in North America and Europe would likely increase the life expectancy of people living with HIV in India by nearly three years and reduce the number of new HIV infections by 23 percent with minimal impact on the country's HIV/AIDS budget. The findings from an international team of investigators have been published online in the Journal of the International AIDS Society.

"This study is the first to show that, in India, changing current therapy to a dolutegravir-based regimen would be safer, save lives and prevent new infections - all without increasing the cost of care," said lead author Amy Zheng of the Massachusetts General Hospital (MGH) Medical Practice Evaluation Center in Boston.

Dolutegravir, developed by the HIV specialist company ViiV Healthcare, has been shown to have fewer side effects and be less likely to induce drug resistance than other currently available HIV drugs. It is currently recommended in North America and Europe as initial therapy for newly infected patients and is available in multiple African countries. A generic version has only recently become available in India.

The researchers used a widely-published mathematical model to project the survival and economic outcomes of adopting a dolutegravir-based regimen as first-line therapy by the Indian health system. Based on cost estimates from the Clinton Health Access Initiative, the analysis assumed the annual cost of the new drug would be $102 U.S. per patient, which is slightly higher than the $98 annual cost of current therapy in India. The team assessed the impact of a dolutegravir-based regimen on life expectancy, the number of new HIV transmissions, HIV care costs and the national Indian HIV budget over 2- and 5-year time horizons.

The results indicated that the new regimen would extend the life expectancy of people living with HIV by 2.8 years and prevent 13,000 new HIV infections over 5 years. Importantly, using dolutegravir as first-line treatment is likely to be cost-effective in 2 years and cost-saving over 5 years - that is, the clinical and public health benefits would be realized at no additional cost to the national government, compared with the costs of the current regimens. Adoption of dolutegravir-based treatment would likely reduce the number of patients who require a switch to more costly and less effective second- and third-line HIV therapies.

Study author Nagalingeswaran Kumarasamy, MD, chief medical officer of the Y.R. Gaitonde Centre for AIDS Research and Education in Chennai, India, says, "Given the size and scope of the HIV epidemic in India, making a dolutegravir-based regimen first-line therapy through the National AIDS Control Organization will provide tremendous benefit to our patients and to India as a whole."

In late 2017, two India-based pharmaceutical companies agreed to provide a generic, dolutegravir-based combination drug to several African countries for $75 per patient per year, a cost even lower than that of current HIV therapy in India. However, in spite of these new advances in HIV therapy in other nations, generic dolutegravir remains out of reach in India - both because of its current costs in that country and because it is not yet the standard therapy - a country in which more than 2 million people live with HIV, the world's third largest population with HIV.

"With India being the world's leading producer of generic HIV therapy, it only makes sense for the tremendous benefits of these therapies to become available to people with HIV in India," added study senior author Kenneth A. Freedberg, MD, MSc, of the MGH Medical Practice Evaluation Center.
-end-
Additional co-authors of the report are Mingshu Huang, PhD, and Rochelle Walensky, MD, MPH, MGH Medical Practice Evaluation Center; A. David Paltiel, PhD, MBA, Yale School of Public Health; Kenneth H. Mayer, MD, Beth Israel Deaconess Medical Center and the Fenway Institute, and Bharat B. Rewari, MD, World Health Organization. The study was supported by National Institute of Allergy and Infectious Diseases grants R01 AI058736 and R37 AI093269 and by the Steve and Deborah Gorlin MGH Research Scholar Award.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals, earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service and returned to the number one spot on the 2015-16 U.S. News & World Report list of "America's Best Hospitals."

Massachusetts General Hospital

Related Hiv Articles:

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.
The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.
Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.
NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
First ever living donor HIV-to-HIV kidney transplant
For the first time, a person living with HIV has donated a kidney to a transplant recipient also living with HIV.
The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.
Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.
HIV RNA expression inhibitors may restore immune function in HIV-infected individuals
Immune activation and inflammation persist in the majority of treated HIV-infected individuals and is associated with excess risk of mortality and morbidity.
HIV vaccine elicits antibodies in animals that neutralize dozens of HIV strains
An experimental vaccine regimen based on the structure of a vulnerable site on HIV elicited antibodies in mice, guinea pigs and monkeys that neutralize dozens of HIV strains from around the world.
State-of-the-art HIV drug could curb HIV transmission, improve survival in India
An HIV treatment regimen already widely used in North America and Europe would likely increase the life expectancy of people living with HIV in India by nearly three years and reduce the number of new HIV infections by 23 percent with minimal impact on the country's HIV/AIDS budget.
More Hiv News and Hiv Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#541 Wayfinding
These days when we want to know where we are or how to get where we want to go, most of us will pull out a smart phone with a built-in GPS and map app. Some of us old timers might still use an old school paper map from time to time. But we didn't always used to lean so heavily on maps and technology, and in some remote places of the world some people still navigate and wayfind their way without the aid of these tools... and in some cases do better without them. This week, host Rachelle Saunders...
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.