Living longer with HIV

Report finds patient can live average 24 years, pay $385,000

November 11, 2006|By Jonathan Bor | Jonathan Bor,Sun reporter

The average patient diagnosed with HIV today can expect to live 24 years - more than triple the life span of those diagnosed with the AIDS-causing virus in the early 1990s, according to experts reporting today in a national medical journal.

But with HIV/AIDS patients living longer and using more sophisticated drug regimens, a lifetime of treatment can cost $385,000 in today's dollars, straining the federal government's ability to provide for those in need.

"It's a very good investment, but it's an investment," said Dr. Bruce R. Schackman, chief of health policy at Weill Cornell Medical College in New York and lead author of a paper appearing in Medical Care, a journal published by the American Public Health Association.

"If funding continues to be flat, a lot of people are not going to be effectively treated and they're more likely to infect other people," he warned.

Despite such warnings, doctors involved in the study said a decade of treatment advances has produced results that were once hard to imagine.

"I was one of those physicians who saw people who died of HIV, and now I'm seeing patients who live with HIV as a chronic illness," said Dr. Kelly A. Gebo, co-author of the study and an AIDS specialist at the Johns Hopkins School of Medicine.

Rather than succumbing quickly to the infections that prey upon people with weakened immune systems, many of today's patients live for decades before dying of heart attacks, strokes and other diseases of aging.

There is some evidence that anti-HIV drugs predispose some patients to high cholesterol, diabetes and heart attack, Gebo said. But the overall benefits are unmistakable.

Feeding data from a national network of AIDS specialty centers into a computer model, the doctors estimated that patients beginning care today can expect to live 24.2 more years, compared with 6.8 years for patients entering treatment in 1993.

When the epidemic emerged in the early 1980s, survival was "measured in months or a few years," Schackman said.

Doctors had only a few drugs at their disposal, none of which attacked the underlying cause of AIDS - infection with a virus that destroyed the immune system. But the mid-1990s ushered in a new era of medications that crippled the virus' ability to invade cells.

Today, patients receiving optimal care take a cocktail of drugs that fight the virus in different ways. It is now common for the virus to retreat to undetectable levels, immune systems to rebound, and patients to return to work and live productive lives.

"It's really the effectiveness of the new combination therapies, and now in particular because we have not just one or two options, but a whole menu of drugs to choose from," Schackman said.

The outlook is not all rosy, however - some patients can't tolerate the drugs' side effects or develop resistance to antiviral medications.

The new projection of life expectancy assumes that patients have access to experienced doctors and the best available medicine. But it does not take into account new drugs that could come onto the market and extend life spans further, Schackman said.

The typical patient seeks care eight years after becoming infected, researchers said. Patients considered in the study were, on average, 39 years old when they entered care. That means they were typically infected at 31 and could expect to live into their middle 60s.

Schackman said the monthly cost of treatment has risen from $1,500 in 1998 to $2,100 today. With patients now able to live more than two decades after diagnosis, the lifetime cost of treatment will surpass $600,000 - which is the equivalent of $385,000 in today's dollars, the authors said.

Federal spending for HIV treatment more than tripled over the past decade to $11.6 billion in 2005. But with patients living longer and the federal government pushing for expanded testing, Schackman said, some patients could be left out unless the government increases its outlay in years to come.

Currently, the Bush administration is proposing little increase in the $2 billion Ryan White program, which covers treatment and other services for needy patients.

In Congress, legislators are debating the administration's proposal to tilt spending from heavily urban states to rural and Southern states - but within the context of flat funding.

"The implication is that waiting lists are going to get longer and people are not going to get the maximum coverage they need," Schackman said, looking ahead several years.

An added burden could come as doctors and patients respond to recent recommendations by the federal Centers for Disease Control and Prevention that HIV testing become a routine part of medical care for people 13 to 64, the doctors said.

The agency hopes to reach many of the estimated 250,000 people in the United States who unknowingly carry the virus because they've never been tested.

Expanded testing could bring a new wave a patients and, with them, added costs.

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