Dear RDI subscriber,
We are writing to you today to tell you about the latest advance with HIV TRePS. Today at the 11th International Congress on HIV Drug Therapy we have an oral late breaker presentation of the use of HIV-TRePS to model the costs, as well as the effectiveness, of antiretroviral therapy. The study indicated that use of the system could reduce the chances of HIV drug therapy failing while at the same time saving costs. The new cost function in HIV-TRePS goes live today at www.hivrdi.org/treps.
In the study, HIV-TRePS was able to identify alternative combinations of available drugs with a higher probability of success in 88% of cases where the drugs actually used in a clinic in rural India failed. The average cost saving was US$638 per patient per year. If these results were extrapolated to the use of the system by half the 50,000 or so people failing therapy in India per year it could potentially save around $20M per year - enough for between 20,000-40,000 additional patients to be treated, while avoiding many cases of virological failure.*
The HIV-TRePS models, which do not require a genotype, were 63% accurate (area under the ROC curve) when tested with 206 TCEs from the cohort in the district of Anantapur, India. They identified alternative regimens that were predicted to produce virological response and with a lower annual cost than the regimen selected in the clinic for all cases. The average annual cost of the alternative regimens identified by the system as being most likely to be effective and least expensive was $515 compared to $1,021 for the regimens used in the clinic.
As you know the system requires a viral load for its predictions, which is not widely used in resource-limited settings. However, the potential cost savings offered by this latest version are likely to cover the costs of viral load testing many times over.
Here are some comments on the results from our collaborators:
"These results are very exciting in that they indicate that HIV-TRePS may be able to deliver useful predictions not only of effectiveness but also cost - the two crucial elements of optimising HIV treatment where resources are scarce," commented Dr Gerardo Alvarez-Uria, Clinical Head of the study based in Anantapur in India.
"Currently, most HIV patients in resource-limited settings are treated according to WHO public health guidelines that offer very limited treatment options", explained Dr Alvarez-Uria. "The new HIV-TRePS system, could enable doctors to tailor the HIV treatment based on the cost and predicted effectiveness of the treatment while taking into account other important factors such as the number of tablets, the side effects of the drugs and interactions with other medication taken by that particular patient".
"These are very encouraging findings", commented Dr. Julio Montaner, Past President of the International AIDS Society and Director of the BC Centre for Excellence in HIV & AIDS, based in Vancouver, Canada. "The current roll-out of antiretroviral therapy to resource-limited settings involves standardised treatment and monitoring protocols. These results suggest that this system could enable individualised treatment, improving outcomes and still saving costs overall."
We hope this development enhances your use of HIV-TRePS.
The RDI team.
Revell AD, Wang D, Alvarez-Uria G et al. Computational models that predict response to HIV therapy can reduce virological failure and therapy costs in resource-limited settings. 11th international Congress on HIV Drug Therapy, Glasgow, Scotland, 2012; Abstract O234.
Date published: 13th November 2012