Millions of Life‐Years Saved with Potent Antiretroviral Drugs in the United States: A Celebration, with Challenges

gained from multidrug antiretroviral therapies (ARTs) since 1989 [1]. Their finding of ~3 million years of life saved in the United States quantifies ART benefits at the population level, complementing the well-known data on plummeting US death rates and lower AIDS case report rates noted in the era of potent therapy [2, 3]. The authors' detailed sensitivity analyses, varying key estimated parameters in their models, indicate that less-conservative assumptions generate an estimate of>5 million years of life saved, a plausible "higher-end" estimate of benefit. The typical HIV-infected person now receiving potent combination ART lives at least 13-14 years longer than if he or she were to forego this therapy or if it were otherwise unavailable [1]. Quantifying the survival benefits of expanded diagnosis and modern care suggests that the economic and humanitarian benefits are greater than were hitherto appreciated. Developing drugs, testing them without undue delay, accelerating their regulatory approval, and making them widely available have saved lives (table 1). That an average of ~200,000 persons in the United States have lived an additional year in each of the past 15 years suggests the gift given to those in need from the labor of many [1]. Drugs are discovered and developed by biochemists, pharmaceutical developers, animal modelers, formulation chemists, microbiologists, pharmacologists, and many others in the pharmaceutical industry, in academia, at research institutes, and in government. Drugs are tested for safety and efficacy by clinical-trials experts, research-study nurses, clinical-trials volunteers, community activists, government scientists and science managers, community workers, health-care providers, pharmacists, ethical-review staff, and allied health workers. After drug approval through the work of pharmaceutical companies and regulatory-oversight experts, implementation depends on health-care workers, blood bankers, social workers, mental-health professionals, substanceabuse treatment providers, journalists, science writers, medical editors, spiritual leaders, corporate and small business leaders, enlightened insurers, and family and friends of patients challenged to receive lifelong polypharmacy. (Of course, our public-health workers in health education and promotion, epidemiology, and community prevention efforts are credited, together with community prevention activists, for laboring to reduce the need for these drugs altogether.) Political and policy leaders influence research and care investments even as health activists push the system to be more responsive and efficient. Central to implementation are the HIVinfected persons themselves, who, by the tens of thousands, keep their appointments, take pills, eliminate or reduce highrisk behaviors, and support peers who struggle with the promising but complex world of daily, lifelong therapy. The model of Walensky et al. gives all of us, from our complementary disciplines, cause for celebration.