Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Reuters NewMedia - Thursday December 24, 1998
Gene Emery

Based on interviews with 2,864 HIV-infected patients in a nationwide survey done in early 1996, the research concludes that the cost of providing that treatment is less than commonly believed -- about $20,000 a year per patient.

"It is deeply disturbing that up to two-thirds of persons with HIV infection are not getting regular care and that even fewer are getting the new multi-drug therapy" that can suppress the human immunodeficiency virus to undetectable levels in the blood, said Dr. Samuel Bozzette of the California think tank RAND who is chief author of the study.

"The data explode the widespread belief that care for the HIV-infected is extraordinarily costly," he said.

Although Bozzette acknowledged that AIDS is "a large and growing burden" for health insurers and the government, he said the findings show that "HIV care is less expensive than care for many other serious diseases" such as heart and kidney diseases.

"The real crisis in paying for HIV care is not its cost, but rather how to finance it," Bozzette said.

Until now, "the cost is commonly believed to be $60,000 to $70,000 a year," said Peter Erbland of the AIDS Action Committee in Boston. But those estimates may have been skewed by the days "when people would go to the hospital with full blown AIDS."

The multi-drug treatment, colloquially called the AIDS cocktail, is allowing people with HIV to live better for longer.

"For people with HIV with no symptoms or minor symptoms, it's a lot easier to treat earlier and treat longer, and the intensive stuff is at the end," Erbland said.

The Centers for Disease Control and Prevention has estimated that between 650,000 and 900,000 Americans are infected with HIV. Bozzette and his team calculated that only 292,000 to 372,000 of them saw a doctor at least once during a six-month period, which was the definition of regular medical care. The reason is that "some people aren't tested (for HIV), some people flee care, or they don't have appropriate access to care, and underfinancing has to be part of that," Bozzette said.

Erbland said it was a question of educating providers as well as people with HIV.

"Doctors who don't treat a lot of HIV cases may not know, for instance, that regular checkups for testing viral load or looking for minor infections that may become life-threatening are important for prevention," he said.

On the other hand, the survey also suggests that when patients are receiving regular care, the medical community is adapting rapidly when new HIV treatments appear.

At the beginning of 1996 only 16 percent of patients were getting the "AIDS cocktail". Yet by the end of that year the number had risen to 55 percent. "That's really encouraging to see that highly effective therapies did diffuse quickly to people under care," said Bozzette.

The survey found that 20 percent of people with HIV have no health insurance; 29 percent are covered by Medicaid, the federal program for the poor; and 19 percent had their treatment covered by Medicare.
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