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首页> 外文期刊>Transactions of the Royal Society of Tropical Medicine and Hygiene >Does a significant reduction in malaria risk make lopinavir/ritonavir-based ART cost-effective for children with HIV in co-endemic, low-resource settings?
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Does a significant reduction in malaria risk make lopinavir/ritonavir-based ART cost-effective for children with HIV in co-endemic, low-resource settings?

机译：疟疾风险的显着降低是否会使洛诺维尔/利特顿韦的艺术对艾滋病毒的儿童具有成本效益，艾滋病毒在合作的儿童，低资源环境中？

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Background: HIV infection and malaria co-infection is not uncommon among children in co-endemic regions, and evidence suggests that HIV is a risk factor for severe malaria among children. HIV protease inhibitors (PIs) are highly effective in pediatric HIV treatment regimens, however, their effectiveness against malaria has been mixed, with some PIs demonstrating in vitro activity against Plasmodium falciparum. Recent findings suggest lopinavir/ritonavir (LPV/r)-based treatment regimens reduce the incidence of malaria infection by over 40% in pediatric HIV patients compared to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. Methods: We assessed whether a significant reduction in malaria risk makes LPV/r-based ART regimens costeffective compared to NNRTI-based regimens in co-endemic, low-resource settings. We modeled the difference in unit cost per disability adjusted life year (DALY) gained among two theoretical groups of HIV+ children under 5 years old receiving ART in a resource-limited setting co-endemic for malaria. The first group received standard NNRTI-based antiretrovirals, the second group received a standard regimen containing LPV/r. We used recent cohort data for the incidence reduction for malaria. Drug costs were taken from the 2011 Clinton Health Access Initiative Antiretroviral (ARV) ceiling price list. DALYs for HIV and malaria were derived from WHO estimates. Results: Our model suggests a unit cost of US$147 per DALY gained for the LPV/r-based group compared to US$37 per DALY gained for the NNRTI-based group. Conclusion: In HIV and malaria co-endemic settings, considerations of PI cost effectiveness incorporating known reductions in malaria mortality suggest a nominal increase in DALYs gained for PIs over NNRTI-based regimens for HIV positive children under five on ART. Our analysis was based on several assumptions due to lack of sound data on malaria and HIV DALY attribution among pediatric populations. Further study in this area is required.
机译：背景：艾滋病毒感染和疟疾共同感染在共同流行区域的儿童中并不少见，证据表明，艾滋病毒是儿童严重疟疾的危险因素。 HIV蛋白酶抑制剂（PIS）在儿科艾滋病毒治疗方案中非常有效，然而，它们对疟疾的有效性已被混合，一些PIS展示了对疟原虫的体外活性。最近的发现表明，与非核苷逆转录酶抑制剂（NNRTI）的方案相比，基因韦韦/鲁顿韦（LPV / R）的治疗方案减少了儿科HIV患者超过40％的疟疾感染的发病率。方法：我们评估了疟疾风险的显着降低是否使基于LPV / R的艺术方案成本效应与基于NNRTI的合作，低资源环境中的NNRTI的方案相比。我们在5岁以下的艾滋病毒+儿童的两种理论群中获得了每年患者的单位成本差异，在5岁以下的疟疾中的资源限制艺术中获得了两种理论群体。第一组接受了基于标准的基于NNRTI的抗逆转录病毒，第二组接受了含有LPV / R的标准方案。我们使用最近的群组数据进行疟疾的发病率。药物成本是从2011年克林顿卫生访问潜力抗逆转录病毒（ARV）天花板价格表中的。艾滋病和疟疾的Dalys来自谁估计。结果：我们的型号表明，基于LPV / R基团获得的单位成本为147美元，而基于NNRTI集团的每达利每年获得37美元。结论：艾滋病毒和疟疾共同流域的环境中，患有已知疟疾死亡率的PI成本效益的考虑因素提出了在艺术中五个艾滋病毒阳性儿童的基于NNRTI的基于NNRTI的基于NNRTI的方案获得的达尔多斯的标称增加。我们的分析基于几种假设，因为患有儿科人群的疟疾和HIV DALY归因缺乏声音数据。需要进一步研究该区域。

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