Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa

Chigwedere, Pride MD*†; Seage, George R III ScD, MPH‡§; Gruskin, Sofia JD, MIA‖¶; Lee, Tun-Hou ScD*†; Essex, M DVM, PhD*†

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 December 2008 - Volume 49 - Issue 4 - pp 410-415
doi: 10.1097/QAI.0b013e31818a6cd5
Perspectives: Epidemiology and Social Science

South Africa is one of the countries most severely affected by HIV/AIDS. At the peak of the epidemic, the government, going against consensus scientific opinion, argued that HIV was not the cause of AIDS and that antiretroviral (ARV) drugs were not useful for patients and declined to accept freely donated nevirapine and grants from the Global Fund. Using modeling, we compared the number of persons who received ARVs for treatment and prevention of mother-to-child HIV transmission between 2000 and 2005 with an alternative of what was reasonably feasible in the country during that period. More than 330,000 lives or approximately 2.2 million person-years were lost because a feasible and timely ARV treatment program was not implemented in South Africa. Thirty-five thousand babies were born with HIV, resulting in 1.6 million person-years lost by not implementing a mother-to-child transmission prophylaxis program using nevirapine. The total lost benefits of ARVs are at least 3.8 million person-years for the period 2000-2005.

From the *Department of Immunology and Infectious Diseases; †Harvard School of Public Health AIDS Initiative; ‡Department of Epidemiology; §Interdisciplinary Program in Infectious Disease Epidemiology; ‖Program on International Health and Human Rights; and ¶Department of Population and International Health, Harvard School of Public Health, Boston, MA.

Received for publication April 3, 2008; accepted August 13, 2008.

P.C. was supported by an Oak Foundation Fellowship through the Harvard School of Public Health AIDS Initiative.

The authors declare that they have no conflict of interest.

Correspondence to: M. Essex, DVM, PhD, Chair, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, FXB 402, 651 Huntington Avenue, Boston, MA 02115 (

© 2008 Lippincott Williams & Wilkins, Inc.