According to two studies published in this week’s Science journal, ramping up HIV antiretroviral treatments in the South African province of KwaZulu-Natal has been worth the extra expense.

According to the findings of the HTPN 052 (HIV Prevention Trials Network 052) trial, people who are HIV positive have a 96% lower chance of transmitting the virus to their partners if they are receiving ART (antiretroviral) medications.

Jacob Bor, from Harvard University, Massachusetts, USA, and team followed up on this trial. They reported that the life expectancy of the average KwaZulu-Natal adult is now 11.3 years longer since ART was expanded in this rural region of the country – life expectancy rose from 49.2 years in 2003 to 60.5 years in 2011.

By local standards, these treatments are not cheap. Annual ART costs between $500 and $900 per year for each person. Experts and agencies had disagreed on whether scaling up such treatments could be justified.

The authors gathered and analyzed data on the changes in adult life expectancies of about 100,000 people from 2000 to 2011. They focused on the difference in life expectancy four years before ARTs were scaled up in the region, and eight years afterwards, and “determined that the survival benefits of antiretroviral treatments exceeded the cost of the treatments 26 times over.”

The longer adult life expectancy in the region was nearly entirely due to changes in HIV-related deaths, they added.

In a related news release from the Harvard School of Public Health, Bor said:

“Many people have been worried that the ART scale-up, which is a massive public health intervention, would negatively affect populations who do not suffer from HIV but need care for other diseases. We do not find any evidence to support this worry.”

In an Abstract in Science, the authors concluded “These gains in adult life expectancy signify the social value of ART and have implications for the investment decisions of individuals, governments, and donors.”

One of the limitations in the study, the authors explained, was that access to clean water and electricity occurred at the same time the antiretroviral treatments were being scaled up. Even so, they added, in a worst-case scenario, increasing access to retroviral treatments in southern Africa would save lives and money.

In another study published in the same journal, Frank Tanser and team discovered that the risk of becoming infected with HIV in sub-Saharan Africa is reduced considerably when ARTs are scaled up.

They followed up 16,667 people who were not infected with HIV in KwaZulu-Natal for a period of eight years after ARTs were expanded in 2004. They found that HIV-free people had a 38% lower risk of becoming infected when they lived in areas with high ART coverage, compared to areas where coverage was low.

For years, experts have been saying that if the South African government started ART for HIV-positive residents earlier, the country would save money and many deaths would be prevented.

Researchers from Weill Cornell Medical College and GHESKIO (Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes) showed in PLoS Medicine that early treatment for HIV is not only a life-saving move, but also a cost-effective one.

Before 2009, WHO (World Health Organization) recommended that antiretroviral therapy for HIV-positive patients should only start when their CD4 T cells went below 200 cells per cubic millimeter. Weill Cornell scientists carried out a randomized clinical trial in Haiti which demonstrated that early ART reduced mortality by 75% in HIV-positive adults with a CD4 cell count between 200 and 350 cells/mm3.

After looking at their findings, WHO changed their recommendation to start ART in HIV-positive patients when their CD4 cell count drops below 350 cells/mm3.

Written by Christian Nordqvist