HIV/AIDS in South Africa are sustained through three years on treatment.

Economic outcomes of patients receiving antiretroviral therapy for HIV/AIDS in South Africa are sustained through three years on treatment.

Although the medical outcomes of antiretroviral therapy for HIV are well described, less is known about how antiretroviral therapy affects patients' economic activities and quality of life, especially after the first year on antiretroviral therapy. The authors assessed symptom prevalence, general health, ability to perform normal activities, and employment status among adult antiretroviral therapy patients in South Africa over three full years following antiretroviral therapy initiation. A cohort of 855 adult pre- antiretroviral therapy patients and patients on antiretroviral therapy for <6> was enrolled and interviewed an average of 4.4 times each during routine clinic visits for up to three years after treatment initiation using an instrument designed for the study. The probability of pain in the previous week fell from 74% before antiretroviral therapy initiation to 32% after three years on antiretroviral therapy, fatigue from 66% to 12%, nausea from 28% to 4%, and skin problems from 55% to 10%. The probability of not feeling well physically yesterday fell from 46% to 23%. Before starting antiretroviral therapy, 39% of subjects reported not being able to perform their normal activities sometime during the previous week; after three years, this proportion fell to 10%. Employment rose from 27% to 42% of the cohort. Improvement in all outcomes was sustained over 3 years and for some outcomes increased in the second and third year. Improvements in adult antiretroviral therapy patients' symptom prevalence, general health, ability to perform normal activities, and employment status were large and were sustained through the first three years on treatment. These results suggest that some of the positive economic and social externalities anticipated as a result of large-scale treatment provision, such as increases in workforce participation and productivity and the ability of patients to carry on normal lives, may indeed be accruing.

These are encouraging findings – this is the first report to indicate that the benefits of antiretroviral treatment in sub-Saharan Africa, in terms of ability to participate in normal activities, fewer symptoms, and increased employment potential, are sustained to 3 years, well beyond the 12 months documented in the existing small body of literature on antiretroviral treatment and quality of life. The proviso is that these patients were those who continued on antiretroviral treatment in these clinical settings – post-enrolment loss to follow-up was high. Some indicators were slow to increase, for example, the probability of having a job did not increase until about 18 months after starting treatment. But the median CD4 count at treatment initiation was low at 105 cells/mm³, unemployment was high in South Africa at a sustained 24% through the study period, and it takes time to find employment after one becomes capable of working. Further studies will help populate the cost-benefit models that inform our thinking about the positive ‘externalities’ of antiretroviral treatment.