Yazdanpanah Yazdan, Losina Elena, Anglaret Xavier, Goldie Sue J, Walensky Rochelle P, Weinstein Milton C, Toure Siaka, Smith Heather E, Kaplan Jonathan E, Freedberg Kenneth A
Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Faculté de Médecine de Lille, France.
AIDS. 2005 Aug 12;19(12):1299-308. doi: 10.1097/01.aids.0000180101.80888.c6.
In 2000, WHO/UNAIDS recommended co-trimoxazole prophylaxis for persons at early stages of HIV infection (WHO stage > or = 2) in sub-Saharan Africa.
To assess the cost-effectiveness of alternative strategies for initiation of co-trimoxazole in Côte d'Ivoire.
Cost-effectiveness analysis with an HIV simulation model using clinical and cost data from a randomized trial of co-trimoxazole in HIV-infected adults.
The study included HIV-infected patients in Côte d'Ivoire, with median age 33 years. Thirty-four percent were classified as WHO stage 2, 59% as stage 3, and 7% as stage 4. The mean CD4 cell count was 331 x 10(6) cells/l. The interventions were no prophylaxis, clinical criteria-based co-trimoxazole initiation (early: WHO stage > or = 2; late: WHO stage > or = 3), CD4-based co-trimoxazole initiation (< 500, < 200, < 50 x 10(6) CD4 cells/l). The outcome measures were life expectancy, lifetime costs, and incremental cost-effectiveness.
The most effective strategy, initiation of co-trimoxazole prophylaxis at WHO stage > or = 2, increased undiscounted life expectancy by 5.2 months, discounted life expectancy by 4.4 months, and lifetime costs by US dollars 60, compared with no prophylaxis. Delaying prophylaxis initiation until WHO stage >or = 3 was less costly and less effective. All CD4-based strategies were dominated. The incremental cost-effectiveness of early versus late co-trimoxazole prophylaxis initiation was US dollars 200/year of life gained. Results were stable despite wide variations in plausible assumptions about bacterial resistance and the prophylaxis efficacy on co-trimoxazole-resistant strains.
For HIV-infected adults in Côte d'Ivoire, co-trimoxazole prophylaxis is reasonably cost-effective and most effective if initiated when WHO stage > or = 2. Early co-trimoxazole prophylaxis will prevent complications prior to antiretroviral therapy initiation and should be considered an essential component of care for early HIV in sub-Saharan Africa.
2000年，世界卫生组织/联合国艾滋病规划署建议在撒哈拉以南非洲地区对处于HIV感染早期阶段（世界卫生组织分期≥2期）的人群进行复方新诺明预防性治疗。
评估在科特迪瓦启动复方新诺明预防性治疗的替代策略的成本效益。
采用HIV模拟模型进行成本效益分析，使用来自一项针对HIV感染成人的复方新诺明随机试验的临床和成本数据。
该研究纳入了科特迪瓦的HIV感染患者，中位年龄为33岁。34%被归类为世界卫生组织2期，59%为3期，7%为4期。平均CD4细胞计数为331×10⁶个细胞/升。干预措施包括不进行预防性治疗、基于临床标准启动复方新诺明预防性治疗（早期：世界卫生组织分期≥2期；晚期：世界卫生组织分期≥3期）、基于CD4启动复方新诺明预防性治疗（CD4细胞计数<500、<200、<50×10⁶个/升）。结局指标为预期寿命、终生成本和增量成本效益。
最有效的策略是在世界卫生组织分期≥2期时启动复方新诺明预防性治疗，与不进行预防性治疗相比，未贴现的预期寿命增加了5.2个月，贴现的预期寿命增加了4.4个月，终生成本增加了60美元。将预防性治疗启动推迟至世界卫生组织分期≥3期成本更低但效果更差。所有基于CD4的策略均占劣势。早期与晚期启动复方新诺明预防性治疗的增量成本效益为每获得一年生命200美元。尽管在关于细菌耐药性和对复方新诺明耐药菌株的预防性治疗效果的合理假设存在很大差异，但结果仍很稳定。
对于科特迪瓦的HIV感染成人，复方新诺明预防性治疗具有合理的成本效益，且在世界卫生组织分期≥2期时启动最为有效。早期进行复方新诺明预防性治疗将在开始抗逆转录病毒治疗之前预防并发症，应被视为撒哈拉以南非洲地区早期HIV治疗的重要组成部分。
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