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.
- 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.