Antiretroviral treatment benefits? from 3 MILLION to 1.2 million to …!?!
Posted by Henry Bauer on 2008/07/18
The claim by Walensky et al., triumphantly cited by Anthony Fauci, was that “at least 3 million” life-years had been saved by antiretroviral drugs since 1989. The fine print, however, noted that only 1.2 million of those had already been realized, the remainder were expected to be accruing to currently living HIV/AIDS patients [HIV/AIDS SCAM: Have antiretroviral drugs saved 3 million life-years?, 6 July 2008]. Now I come across information showing that even this 1.2 million overstates matters.
The total benefit claimed by Walensky was calculated by them for 6 eras of treatment approach:
Let’s assume PCP prophylaxis yielded savings of only 3.1 months per person in later eras as well as in the first. Then the savings attributed to it amount to 58,000 years in the 2nd era, 19,000 in the 3rd, 14,000 in the 4th, 19,000 in the 5th, and 6,000 in the 6th, giving a total (including the 41,000 in the first era) of 157,000 life-years saved through PCP prophylaxis alone.
But how did Walensky et al. decide that PCP prophylaxis had this survival benefit? Their leading reference regarding PCP prophylaxis is:
“2. Ioannidis JP, Cappelleri JC, Skolnik PR, Lau J, Sacks HS. A metaanalysis of the relative efficacy and toxicity of Pneumocystis carinii prophylactic regimens. Archives of Internal Medicine; 156 (1996) 177–88.”
That article analyzed 35 randomized trials. It excluded one of those from mortality considerations because “mortality data were dominated by the early trial of Fischl et al. (15) in which the mortality from PCP was 50% and PCP accounted for 29% of all deaths in the placebo group. When this study was excluded, prophylaxis . . . offered no survival benefit over placebo (risk ratio 1.00 [95% CI, 0.72 to 1.39]). Similarly, no significant difference was seen in overall mortality among different prophylactic regimens”.
The Fischl trial was of a cohort of people already diagnosed with Kaposi’s sarcoma; Fischl et al., JAMA 259  1185-9. Half of those treated with Bactrim prophylaxis had “adverse reactions”. The authors commented that this drug is known to cause bone-marrow suppression, which would be enhanced by the antiretroviral then in use, AZT = zidovudine, which has the same “side”-effect.
In concluding comments, Ioannidis et al. again note the lack of survival benefit: “P carinii prophylaxis significantly reduced P carinii events and P carinii-related deaths, but there was no statistically significant reduction in the overall mortality of patients who received prophylaxis”.
Evidently the estimate of benefits of anti-HIV treatment needs to be further reduced below 3 million 1.2 million.
In every form of treatment, what matters to patients is quality of life and a possible reduction in all-cause mortality: it’s no gain if one dies just as soon or sooner from the drugs than from the ailment. It is by no means routine, unfortunately, for all-cause mortality to be reported in clinical trials; that lack is emphasized in Joel Kauffman’s rigorously researched book, Malignant Medical Myths.
This entry was posted on 2008/07/18 at 3:34 pm and is filed under antiretroviral drugs, clinical trials, HIV/AIDS numbers. Tagged: benefits of antiretroviral treatment, HAART, PCP prophylaxis. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.