Implementing a Patient-Centered Approach for HIV Management

At the 2021 Fall Managed Care Forum, Ian Frank, MD, professor of medicine at Perelman School of Medicine at the University of Pennsylvania, discussed the emerging treatment strategies for patients living with human immunodeficiency virus (HIV), as well as placing those new options in the context of the economics of managing HIV illness.

Describing the epidemiology of HIV, Dr. Frank noted that people with HIV infection are now living longer, with trends in annual death rates among Americans aged 25 to 44 years dropping continuously since the late 1990s. Those survival gains are precipitated by effective HIV treatments. But, as patients live longer, aging with HIV infection is associated with an increased risk of common comorbidities, he noted.

The basic principles of HIV treatment are that all patients with HIV should be treated, with a goal of reducing the HIV viral load to undetectable levels, Dr. Frank explained. Antiretroviral agents are the recommended first-line regimens in most patients with HIV infection and are highly effective with low rates of treatment failure.

Patients with HIV will often switch therapy during their treatment course, for reasons of convenience, to avoid toxicities, and to avoid drug-drug interactions. The availability of pre-exposure prophylaxis for HIV prevention is also hopefully leading to a reduction in HIV incidence, Dr. Frank noted.

Regarding the economics of treating HIV, Dr. Frank outlined the value of universal treatment to reduce viral loads to undetectable levels. Patients with undetectable levels of HIV viral load rarely get HIV-related complications that require hospitalization, representing the opportunity to avoid hospitalizations and save costs. However, he said, “failure to link and retain people in care in the U.S. is the main obstacle to successful outcomes of HIV. For many, social support is critical for treatment success.”

He then compared the wholesale acquisition costs for some common treatment regimens – which range from $2,315 to $4,752 per month – adding that generics and less-expensive combinations might be able to replace more expensive agents in some situations. Overall though, “effective therapy reduces costs, no matter what’s used,” he said.