Drug Treatment Options for HIV/AIDS
Many encouraging developments have occurred in the fight against HIV/AIDS. A class of drugs called protease inhibitors — when used with existing drugs — offers renewed hope in the treatment of HIV/AIDS. Since their introduction in 1995, mortality in the U.S. related to AIDS has dropped from 51,670 deaths in 1995 to 15,603 in 2001. The number of people living with HIV/AIDS has also increased from 215,000 in 1995 to over 330,000 in 2001, despite a flat trend in the number of new HIV infections.
However, these combination therapies, known as highly active antiretroviral treatment (HAART), are costly and must be used indefinitely. The primary federal programs that provide access to combination therapies for the poor and uninsured are Medicaid and the Ryan White CARE Act's AIDS Drug Assistance Program. As people with HIV/AIDS are living longer lives, the need for these federal resources to provide life-saving drugs will continue to increase.
Protease Inhibitors
Protease inhibitors block a part of HIV called protease, allowing HIV to make copies of itself that cannot infect new cells. In order to minimize the levels of HIV in the body, early intervention in the disease progression is more important than ever.
Recent studies have shown that protease inhibitors can help people live longer and get fewer opportunistic infections. The inhibitors also appear to have fewer side effects than earlier anti-HIV drugs. It is critical, however, that those who take protease inhibitors have an uninterrupted supply of the drugs because the body quickly creates a permanent resistance to the medication if not taken consistently.
Fusion Inhibitors
Fusion inhibitors are the newest class of approved antiretroviral drugs aimed at combating AIDS. These drugs interfere with the HIV virus’ ability to fuse with and enter a healthy host cell. Pentafuside was the first drug approved in this category.
Combination Therapy
Combining protease inhibitors with older antiretroviral drugs effectively reduces the viral load of HIV within the body by attacking the virus at different stages in the replication process. Reduction of the viral load has been linked to improved health. Combination therapy also appears to help the drugs remain effective for longer periods of time and make resistance less of a problem.
Annual medical care for a person with HIV/AIDS, including combination therapy, costs between $15,000-plus each year. Viral load tests cost from $80 to $300 each and must be administered every few months. Many patients may also require other medications to prevent or treat various opportunistic infections.
Combination therapies are the standard of care. In papers published in September 1997, investigators supported by the National Institute of Allergy and Infectious Diseases conclusively demonstrated that triple-drug combinations with a protease inhibitor and two other anti-HIV drugs were more effective than one- or two-drug regimens for long-term suppression of HIV. The U.S. Department of Health and Human Services releases guidelines for the use of antiretroviral AIDS drugs and combination therapies, aiming to help doctors and patients decide which drugs to use and when — based on a variety of factors, including the progress of HIV infection. These guidelines recommend early and aggressive treatment for people with HIV, even those with no symptoms.
AIDS Drug Assistance Program
The AIDS Drug Assistance Program, or ADAP, is available for people who have no health insurance with prescription drug coverage and who are ineligible for Medicaid. States administer the ADAP program and have various mechanisms for distributing drugs. Under federal guidelines, states establish their own financial and medical eligibility criteria for enrollment in ADAP.
Title II of the Ryan White CARE Act provides the federal contribution to the ADAP program. Notably, the need for services far outweighs available services. And despite increases in funding for ADAP, some states limit access to drugs because of budget shortfalls.
Currently, AIDS Drug Assistance Programs across the country are limiting the number of drugs they provide and restricting access to their programs to stay financially solvent. Without increased funding for ADAP, many people will not have access to life-saving drugs, and the gap will widen between a high quality, standard treatment regimen and the treatment regimen that ADAP can actually provide.
Medicaid
Discrimination, pre-existing condition exclusions, lifetime coverage limits, experience rating and other practices all put people with HIV at risk for denial of health care coverage. As a result, people with HIV rely heavily on public assistance to pay for their health care. Many with private health insurance also rely upon public programs for medical needs that their insurance will not pay.
Medicaid provides care to over 50 percent of adults and more than 90 percent of children with AIDS. States are required to provide Medicaid to certain population groups such as low-income children, pregnant women and people receiving federal cash assistance. However, eligibility for other groups such as certain disabled adults, including people with AIDS, is optional.
The optional eligibility category that is most important for people living with HIV/AIDS is the medically needy category. Through this option, states extend eligibility to individuals who initially have too much income to qualify for Medicaid but then become impoverished as a result of their health care expenses. States are not required to provide to their medically needy population the same range of benefits available to other categories of people. Therefore, depending on the state's eligibility requirements and benefits package, treatments important for people with HIV and AIDS, including prescription drugs, may not be covered. For more information, see Medicaid Expansion and Early Treatment for HIV Act.
