There are several important questions bug chasers need to ask before they commence the active chasing stage, with one of the questions being the cost of Human Immunodeficiency Virus (HIV) medication. Once our body has become infected with HIV, the virus will continue to replicate and create copies of itself and when this happens, the virus becomes stronger and our body becomes weaker. As a result, most people who become HIV-positive will need to take antiretroviral medication to manage the virus, although there are a small number of people known as ‘elite-controllers’, also known as Long-Term Nonprogressors (LTNP) who manage to control the virus without needing to take antiretroviral medication, but this situation is considered to be very rare.
According to the World Health Organisation (WHO), a person living with HIV who has not been diagnosed or is not taking antiretroviral medication will develop signs of HIV-related illnesses within 5 to 10 years, although it can be sooner and the time between HIV transmission and an AIDS diagnosis is usually 10 to 15 years, but it can sometimes be longer. Based on these timeframes, it’s important to understand that most people who become HIV-positive will eventually need to take antiretroviral medication, otherwise their body will become compromised by infections, which can lead to serious health issues, including death, which happens because the white blood cells that are designed to protect us have been destroyed by HIV and can no longer protect us from opportunistic infections.
HIV is a life-long chronic illness, which does not currently have a cure, although a small number of people have achieved a ‘functional cure’ by undergoing a bone marrow transplant for cancer, with re-infusion of new CD4 T-cells that are unable to be infected with HIV. Although there is no current cure for HIV, antiretroviral medication can prevent the virus from replicating within the body, which can lead to an infected person reaching an undetectable HIV status after 6 months of continuous treatment. It has also been established that some people of European descent have a genetic mutation known as CCR5-delta 32, which hampers HIV’s ability to infiltrate immune cells, so it is possible for some people to be exposed to HIV, yet never become infected with the virus.
There are two things that happen when a person becomes infected with HIV. A person’s CD4 count drops and their viral load increases. A normal CD4 count for those not infected with HIV is between 500 to 1,500, but this count will drop to between 200 and 500 when a person is HIV-positive and in good health, but when their CD4 count drops below 200, this is considered to be high-risk and can expose the person to a higher number of illnesses and infections. A viral load under 200 is considered undetectable, so the virus cannot be transmitted to other people, but once the viral load is above this number, it’s possible for the virus to be transmitted to other people. A viral load below 10,000 is considered low for people who are HIV-positive and not on treatment, but a viral load between 100,000 to 1,000,000 is high for people who are HIV-positive and not on treatment, making the virus more infectious.
HIV antiretroviral medication is designed to stop the virus replicating inside the body. This medication does not eliminate the virus from the body, it simply controls the reproduction lifecycle, which means the virus never leaves the body, it simply remains at an undetectable level, so those infected with the virus can live a normal life whilst taking the medication and it also means that those who have achieved an undetectable viral load cannot transmit the virus to anyone else. Antiretroviral medication is highly advanced and it needs to be, because the virus is very sophisticated and has the ability to change its genetic structure, and when this happens, it can result in medication being ineffective at at blocking the replication of the virus, which is known as drug resistance.
At the end of 2021, 28.7 million people were taking antiretroviral medication out of an estimated 38.4 million people who were living with HIV according to the World Health Organisation (WHO). Up to 10% of adults starting HIV treatment can have drug resistance to the non-nucleoside reverse transcriptase inhibitors (NNRTI) drug class, with resistance up to 3 times more common in people with previous exposure to antiretroviral drugs. For this reason, a variety of different drugs are available to treat HIV, with several levels of therapy available, which all come with different cost considerations, with it generally meaning that the cost structure increases based on the type of drugs required.
The first-line of HIV therapy, known as the initial antiretroviral drug regime for an HIV-infected patient is usually cheaper than subsequent second-line or third-line therapies. For patients who failed first-line therapy, it may become necessary to transfer them to second-line therapy in order to suppress HIV viral loads and for those patients who failed second-line therapy, it may be necessary to transfer them to third-line therapy. Antiretroviral medicine combines several different types of drugs that target different stages of the HIV lifecycle by introducing inhibitors that are designed to stop the virus from replicating and reducing the viral load.
When it comes to HIV treatment, the cost is an important consideration. Some countries subsidise the cost of medication through governments, employers, insurance companies or organisations, that makes the medication more affordable, but some countries do not provide this assistance or people might not meet the criteria for any of these assistance categories, which leaves the consumer (or patient in this case) responsible for the entire cost of the medication. There are a number of medications recommended for first-line HIV treatments, including those in the following table, although generic brands might be available at a lower cost:
| BRAND | DOSAGE | QUANTITY | DAILY COST | MONTHLY COST | ANNUAL COST |
|---|---|---|---|---|---|
| Tivicay | 50-mg tablet | 30 tablets | $80.46 | $2,414 | $28,968 |
| Descovy | 25-mg/200-mg tablet | 30 tablets | $81.56 | $2,447 | $29,364 |
| Dovato | 50-mg/300-mg tablet | 30 tablets | $106.10 | $3,183 | $38,196 |
| Triumeq | 50-mg/600-mg/300-mg tablet | 30 tablets | $133.56 | $4,007 | $48,084 |
| Biktarvy | 50-mg/25-mg/200-mg tablet | 30 tablets | $143.36 | $4,301 | $51,612 |
This article primarily discusses the financial costs associated with HIV, but there are other questions that need to be asked as well, from a health and social perspective. Anyone who feels connected to bug chasing or who is on the bug chasing path needs to take their time and ask as many questions as needed to fully understand what bug chasing entails before embracing the need to contract the virus and embarking on the bug chasing journey, as there’s a number of implications that need to be considered beforehand. For some, the risks are too high, but for others, the risks have been assessed and are deemed to be acceptable to them, which comes down to each individual making the decision that’s right for them based on their situation and personal circumstances.
Further Reading:
- HIV/AIDS Questions and Answers
- Recommended Treatments for HIV
- Cost Considerations and Antiretroviral Therapy
Featured Photo: Miguel Á. Padriñán from Pixabay.
Article ID: CC060
Version Control: 1.1 – April 10, 2023: Added the term Long-Term Nonprogressors (LTNP) to the article
Version Control: 1.0 – March 26, 2023: Original article published.
In the U.S., it’s my understanding that many established but pricy medications are covered by the drug companies offering rebates for a month or two that somehow count against insurance deductibles leaving little or no out-of-pocket costs for those taking the prescription. That’s been the case for me so far. Turning 65 and going on Medicare is a great unkown for me at this point.
I am on medicare. With Medicare we purchase our drug plan separately and there are a variety of options. Here in Wisconsin check with your County Aging and Disability Resource Center before you sign up with Medicare and they will walk you through the options. If we have lunch one day it’ll be easier to discuss.
Thanks for that response as it’s quite helpful. We will have to meet up soon!
Let’s do it John, Weekdays work best for me as I have a long running weekend project underway.
Great Read, Thank You Jason!
Thanks Matt, I’m glad you enjoyed reading this article.
I feel it important to let people in the United States know that is can be extremely difficult if not impossible to find a Medicare Part D plan that covers HIV medications. This is important to know when making decisions that will likely affect the rest of your life. I’ve had a few friends that upon reaching age 65 and receiving Medicare, we’re extremely surprised to find no plan that covered their medications.
There are assistance programs but they are not without their limits. One of my friends was fortunate to still be working and covered under his employer provided plan. He was eventually able to retire at 70 but had to move to another state to get coverage.
These assistance plans are available to any age patient in need, however the hurdles and red tape can be a quite a bother.
As I get older and am forced to deal with consequences of my actions, I freely admit to regrets, I prefer not to be flamed for admitting this, but where I am today causes me a lot of regrets. If I had it to do over again, I would do things differently, and not get HIV. In my case, sexuality and morality went sideways when I was 6 and being abused by an 18 year old relative. Had it not been for that experience, I am sure I would have turned our very differently. Yes, I had experiences that most didn’t back then, but the consequences of all of it left me a very crumbled cookie that now lives with a lot of regrets.
As is the case with so many things we do early in our lives, the full consequences are not realized until much later. The old saying of “do as I say, not as I do” seems perfect for this. Prep costs little yet it gives you so much more possibilities down the road. And good god, the gay community simply must kick its drug habits. Here in the USA, we have come a very long way towards normalizing being gay? And the social stigmas are largely going away, so why do we continue our self destructive ways? It is damn time the gay community grow the F up, and act in healthier ways.
Thank you for providing some really important insight into this issue Scott, as you have highlighted a number of things bug chasers need to think about. Thinking ahead is an opportunity that allows us to decide whether intentional HIV transmission is something we really want to pursue after we’ve weighed up the pros and cons. What you have shared with us based on your own experiences and that of your friends is something that’s extremely important to consider, as many who are covered by insurance or Medicare right now, might not be eligible in the future, which is why fully understanding everything involved with becoming intentionally HIV-positive is essential. This can allow us to decide whether to proceed, pause, abandon or get things into alignment.
I want to acknowledge that it might have been difficult to share what you have said here, but I really appreciate your honesty, because this is exactly what we need to know about to help us make decisions that will affect our future and bug chasing can have some really serious outcomes. I’m really sorry to hear about the sexual abuse you endured as a child and it may have likely been a contributing factor to other things that have happened afterwards. Thank you again for being honest and saying what you have said to help anyone with their decision-making who is considering becoming HIV-positive on purpose based on your own experiences.
You are so right about things becoming fully understandable after the fact and when it comes to becoming HIV-positive, this is permanent and cannot be changed in our lifetime (at this stage). This is why you sharing what you have said here is so important and I greatly appreciate you doing this. I acknowledge there is a lot of drug use in the gay community and this is something I want to discuss here, as it’s something that’s happening and is known to have connections to HIV infections, so I’ll be putting together an article about this in the future.
Thank you, the struggle of being a pervy sex guy for me, is that I’m actually a decent guy. I have a set of rules shall I say about who I will fuck. A person who claims to be negative and wanting it, AND doing things likely to end with infection anyway, in short, these are the guys I’ll fuck.
I’m sure you’re a decent guy Scott and I can tell this from what you’ve shared here and I also think your sexual criteria makes very good sense.
A very thought provoking article. The cost of these meds is astronomical but that is probably true for many medicines which are covered by insurance. I do note the cost is listed daily and monthly. February is a shorter month so perhaps I shall only take meds in February. Seriously, this is why health care is so important in this country and around the world
The cost of various medications can be astronomical and thankfully there’s ways for the costs to be reduced for a large number of people around the world, but the point you have raised is a good one. High quality healthcare for all is extremely important, that way everyone has access to the medications and services they need. The cost of HIV medication where I live works out to be $1 a day and even less for some, which is fantastic and makes it affordable for anyone who needs it. You made me smile with your February comment Tom, but I do note the serious issue you raised in your comment as well.
I am aware that not taking meds means I will likely get AIDS
Yes, this is true Alfred, so it’s good that you are aware of this.
That is a very interesting article Jason. The cost of HIV meds will not deter me from becoming hiv positive. When I become poz I plan on not taking meds
I’m glad you found this article interesting Alfred and it’s good to hear you have considered this issue and have already decided what you want after you become poz.
Thanks for sharing with us Jason. Love reading your synopsis and reviews of the latest news in the HIV world. I have good health care available for me and reasonable out of pocket costs. Some people don’t even in the USA.
Thanks Steven. I try to include articles about HIV and other topics to ensure we’re all aware of everything that’s involved, even if they’re sometimes serious, like this article is. It’s really good to hear that you have good healthcare available, with reasonable out of pocket expenses, because this is so important. That’s very true about some people not having good healthcare in the United States, which is why affordability is an important consideration. Hopefully those who don’t have access to good healthcare at the moment will be able to access it in the future, whether that’s through insurance, making changes to their current circumstances or finding assistance that might be available, yet isn’t always easy to find.
Very interesting article, Jason it’s a serious question to figure out but for me no meds as long as possible. But, there is another important point, it’s the Side effects of the drugs.
You have raised another important consideration Dark, which is the side-effects of the drugs. This article was starting to become intense and I didn’t want to overload it with too much more information, so I’m planning to write a separate article that talks more about HIV antiretroviral medication, including side-effects based on some case studies. There’s definitely a lot to think about, including whether to start taking medication right away, wait a while or leave it as long as possible. I appreciate your comment and thank you again for highlighting another important consideration relating to HIV medication.
You’re welcome Jason! For the next article. Yeah sometime the side-effects are worst than hiv. The costs in the article are they the first Line?
The side-effects can vary from person to person and when this happens, healthcare providers will usually try a different brand of medication to find a drug that is both effective and comes with less side-effects. The costs mentioned in this article are for first-line treatment in the United States, without any subsidies being applied, but generic brands (where available) are available at a lower price.