Despite growing international pressure to provide HIV-1 treatment to less-developed countries; potential demographic and epidemiological impacts have yet to be characterised. We modelled the future impact of antiretroviral use in south Africa from 2000 to 2005.

methods:

We produced a population projection model that assumed zero antiretroviral use to estimate the future demographic impacts of the HIV-1 epidemic. We also constructed four antiretroviral-adjusted scenarios to estimate the potential effect of antiretroviral use. We modelled total drug cost; cost per life-year gained; and the proportion of pe-person health-care expenditure required to finance antiretroviral treatment in each scenario.

Findings:

With no antiretroviral use between 2000 and 2005; there will be about 276000 cumulative HIV-1-positive births; 2;302;000 cumulative new AIDS cases; and the life expectancy at birth will be 46.6 years by 2005. By contrast; 110;000 HIV-1-positive births could be prevented by short ourse antiretroviral prophylaxis; as well as a decline of up to 1 year of life expectancy. The direct drug costs of universal coverage for this intervention would be US$54 million - less than 0.001of the per-person health-care expenditure. In comparison; triple-combination treatment for 25of the HIV