The clinical and economic impact of genotype testing at first-line antiretroviral therapy failure for HIV-infected patients in South Africa

Julie H. Levison, Robin Wood, Callie A. Scott, Andrea L. Ciaranello, Neil A. Martinson, Corina Rusu, Elena Losina, Kenneth A. Freedberg, Rochelle P. Walensky

Research output: Contribution to journalArticlepeer-review

Abstract

Background. In resource-limited settings, genotype testing at virologic failure on first-line antiretroviral therapy (ART) may identify patients with wild-type (WT) virus. After adherence counseling, these patients may safely and effectively continue first-line ART, thereby delaying more expensive second-line ART.Methods. We used the Cost-Effectiveness of Preventing AIDS Complications International model of human immunodeficiency virus (HIV) disease to simulate a South African cohort of HIV-infected adults at first-line ART failure. Two strategies were examined: no genotype vs genotype, assuming availability of protease inhibitor-based second-line ART. Model inputs at first-line ART failure were mean age 38 years, mean CD4 173/μL, and WT virus prevalence 20%; genotype cost was $300 per test and delay to results, 3 months. Outcomes included life expectancy, per-person costs (2010 US dollars), and incremental cost-effectiveness ratios (dollars per years of life saved [YLS]).Results. No genotype had a projected life expectancy of 106.1 months, which with genotype increased to 108.3 months. Per-person discounted lifetime costs were $16 360 and $16 540, respectively. Compared to no genotype, genotype was very cost-effective, by international guidance, at $900/YLS. The cost-effectiveness of genotype was sensitive to prevalence of WT virus (very cost-effective when prevalence ≥12%), CD4 at first-line ART failure, and ART efficacy. Genotype-associated delays in care ≥5 months decreased survival and made no genotype the preferred strategy. When the test cost was

Original languageEnglish (US)
Pages (from-to)587-597
Number of pages11
JournalClinical Infectious Diseases
Volume56
Issue number4
DOIs
StatePublished - Feb 15 2013

Keywords

  • antiretroviral treatment failure
  • HIV
  • resistance testing
  • resource-limited settings

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Fingerprint

Dive into the research topics of 'The clinical and economic impact of genotype testing at first-line antiretroviral therapy failure for HIV-infected patients in South Africa'. Together they form a unique fingerprint.

Cite this