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Nonantiretroviral Drug Consumption by CD4 Cell Count in HIV-Infected Adults: A 5-Year Cohort Study in Côte d'Ivoire

Nombela, Nohelly MPH*; Kouadio, Bertin MPH; Toure, Siaka MD, MPH; Seyler, Catherine MD, MSc; Flori, Yves-Antoine PhD*; Anglaret, Xavier MD, PhD*†

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1st, 2006 - Volume 41 - Issue 2 - p 225-231
doi: 10.1097/01.qai.0000179456.39185.9b
Epidemiology and Social Science

We followed a cohort of 592 HIV-infected adults during 1292 person-years in Abidjan before the highly active antiretroviral therapy (HAART) era. On the basis of the exhaustive monitoring of nonantiretroviral drugs actually delivered to the patients and of the real cost of drugs at the cohort center's pharmacy during the study period, we estimated the mean cost of drugs per person per year (MCPPY) overall, by drug characteristics, and by patients' baseline CD4 cell count. The MCPPY was $198 US overall and $83 US, $101 US, $186 US, $233 US, and $459 US in patients with a baseline CD4 count ≥500 cells/mm3, 350 to 499 cells/mm3, 200 to 349 cells/mm3, 100 to 199 cells/mm3, and <100 cells/mm3, respectively. The most costly classes of drugs were the antibacterial (MCPPY $30 US), the antifungal ($16 US), and the analgesic ($6 US) classes in patients with a baseline CD4 count ≥500 cells/mm3 versus the antifungal ($208 US), the antibacterial ($49 US), and the antiparasitic ($31 US) classes in patients with a baseline CD4 count <100 cells/mm3. These data could be used in further cost-effectiveness analyses that seek to prioritize health interventions. Meanwhile, they roughly suggest that successful antiretroviral treatment, which would stabilize the CD4 count above 500 cells/mm3, could reduce by 5-fold the cost of nonantiretroviral drugs in HIV-infected adults in Abidjan.

From the *Unité INSERM U.593, Université Victor Segalen, Bordeaux, France; and †Programme PAC-CI, Abidjan, Côte d'Ivoire.

Received for publication August 3, 2004; accepted June 21, 2005.

Supported by the Agence Nationale de Recherches sur le SIDA (ANRS, France) and the Programme National de Lutte contre le SIDA, les maladies sexuellement transmissibles et la tuberculose (PNLS/MST/TUB, Côte d'Ivoire) within the collaborative Programme PAC-CI.

Reprints: Nohelly Nombela, Unité INSERM 593, Université Victor Segalen, Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux, Cedex, France (e-mail: nnombe@yahoo.fr).

© 2006 Lippincott Williams & Wilkins, Inc.