Studies Examine Cost Effectiveness of Male Circumcision, Predictors of HIV Progression
The following highlights recently released journal articles on HIV/AIDS.
- "Absolute Count and Percentage of CD4+ Lymphocytes Are Independent Predictors of Disease Progression in HIV-Infected Persons Initiating Highly Active Antiretroviral Therapy," Journal of Infectious Diseases: Todd Hulgan of Vanderbilt University School of Medicine's Division of Infectious Diseases and colleagues conducted the study among 1,891 participants who began HAART regimens between 1997 and 2004 and received more than 30 days of therapy and who had baseline values of CD4+ T cell counts, CD4 percentages and HIV-1 RNA. The researchers used a proportional-hazard model to determine the link between CD4 percentage and disease progression and found that of the 1,891 participants, 468, or 25%, experienced disease progression during the study. They conducted a multivariable analysis that included age, race, sex, HIV-1 RNA, previous antiretroviral therapy, likely transmission route, prior AIDS-defining events, CD4 count and CD4 percentage. According to the study, previous antiretroviral therapy, injection drug use, and lower CD4 count and percentage predicted disease progression. The researchers concluded that CD4 percentage at the start of initial HAART regimens can predict disease progression independent of CD4 counts and that CD4 percentage can be used to determine the timing of HAART therapy (Hulgan et al., Journal of Infectious Diseases, February 2007).
- "Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting," PLoS Medicine: James Kahn of the Institute for Health Policy Studies at the University of California-San Francisco and colleagues conducted the study among 1,000 adult men in Orange Farm, a township outside Johannesburg, South Africa, Reuters reports. The study found that circumcising the men would prevent about 300 new HIV cases over 20 years. According to the researchers, the circumcisions translated to a total savings of about $2.4 million, which could have been spent on providing HIV/AIDS treatment for participants in the study group alone. "I would say we're making two points -- it's an effective strategy, and it's cost-effective," Kahn said. He added that the study could have implications for other African countries. "The estimate is that a fully scaled-up program might save ... well over $5 billion in savings if it were done throughout sub-Saharan Africa based on the infections prevented over 10 years," Kahn said (Reuters, 12/25/06).