The average patient diagnosed with HIV today can expect to live 24.2 more years, more than triple the life span of those diagnosed with the AIDS-causing virus in the early 1990s, according to a new study.

But with HIV/AIDS patients living longer and taking more sophisticated drug regimens, a lifetime of treatment could cost more than $600,000 per patient, straining the federal government’s ability to provide for those in need.

Doctors involved in the study said a decade of treatment advances produced results that were once hard to imagine.

When the epidemic emerged in the early 1980s, survival was “measured in months or a few years,” said Dr. Bruce Schackman, chief of health policy at Cornell University’s Weill Medical College in New York. He is lead author of the paper in Medical Care, a journal published by the American Public Health Association.

Funding for treatment is “a very good investment, but it’s an investment,” Schackman said.

“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.”

Feeding data from a national network of AIDS centers into a computer model, researchers estimated that patients today can expect to live 24.2 years after starting treatment, compared with 6.8 years for patients entering treatment in 1993.

“I was once 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 Gebo, co-author of the study and an AIDS specialist at the Johns Hopkins School of Medicine in Baltimore.

The study could influence how much state and federal governments appropriate for HIV and AIDS care and prevention in the future, some HIV-policy experts said.

Federal spending for HIV treatment more than tripled in 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 spending.

Death by other causes

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.

What changed? Since the mid-1990s, about two dozen HIV-fighting anti-retroviral drugs have come onto the market,

essentially turning HIV from a death sentence into a chronic disease.

Physicians have come to understand life expectancy after HIV diagnosis to be two decades or more, and the new study supports that belief.

“It’s nice to see that in writing,” said Dr. Carlos del Rio, co-director of Emory University’s Center for AIDS Research.

Patients today receiving optimal care take a cocktail of drugs that fights the virus in different ways. It is common for the virus to retreat to undetectable levels, immune systems to rebound and patients to hold jobs and live productive lives.

Although there is evidence the drugs predispose some patients to high cholesterol, diabetes and heart attacks, the overall benefits are unmistakable, Gebo said.

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

The researchers drew most of their data from 18 medical practices across the United States that provide care for 14,000 patients. The researchers looked at the records of about 7,000 of those patients.

They used a computer-simulation model to project HIV medical-care costs and concluded the average lifetime cost of HIV care is $618,000 per person.

That figure is roughly equivalent to lifetime cost estimates for heart disease and some other chronic conditions in women, who incur more costs than men because they live longer, the researchers said.

The researchers estimated the monthly cost of care at $2,100, with about two-thirds of that spent on medications. That equates to $25,200 a year. In 1998, the average annual cost was $18,300, according to an older study.

Care uneven

But the best available drugs and the best standards of care aren’t always what’s provided, some experts noted. For example, a 2003 federal study concluded only 55 percent of HIV patients who should have been on virus-fighting medications were getting them.

“This is really an optimistic scenario” in the study, and the true cost is probably lower, said Jennifer Kates, director of HIV policy for the Kaiser Family Foundation.

Additional costs could come as doctors and patients respond to recent recommendations by the federal Centers for Disease Control and Prevention (CDC) 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. Expanded testing could bring more patients and, with them, added costs.

Source Seattle Times

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