Human immunodeficiency virus (HIV)affects around 1.2 million people in the United States.Great strides have been made to improve life expectancy with HIV infection, especially when the virus is diagnosed early. However,there is no cure. A lifetime of doctor’s appointments, testing, and treatments are needed to manage HIV. And aside from being vital for survival, these treatments are expensive.
This article discusses the relationship between the cost and the effectiveness of HIV treatment. It also examines how lifetime cost varies depending on when treatment begins.
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What Is Lifetime Cost?Lifetime cost is the total cost of healthcare and treatment spent between the time a person is diagnosed with an illness until their death.
What Is Lifetime Cost?
Lifetime cost is the total cost of healthcare and treatment spent between the time a person is diagnosed with an illness until their death.
HIV Care Expenses
HIV is a virus that attacks the immune system. It it’s not treated, it will advance through all three of the following stages without exception:
HIV treatment begins as soon as the diagnosis is made. It’s also from this point that HIV-care costs begin.
Your lifetime cost for HIV care is the total amount you can expect to pay for the following:
Your bills may vary from year to year, depending on how stable your condition is, how often your doctor orders tests, what your insurance covers, and more.
Lab Tests
There aretwo types of lab teststhat you will need to take regularly: a test that measures your CD4 count, and a test that measures your viral load.
CD4 tests: Your CD4 count will be monitored regularly to see how far the infection has advanced and if treatment is working to protect your CD4s.
In the first two years after your diagnosis, your CD4 count will be measured every three to six months with a simple blood test. After that, it may be measured every six to 12 months.
HIV viral load tests: These blood tests measure how many HIV particles are in an HIV-positive person’s blood. Viral load is repeated every three to four months or as clinically indicated to confirm continuous viral suppression. The interval may be extended to six months for people who are adhering to treatment whose viral load has been suppressed for more than two years and whose clinical and immunologic status is stable.
A good sign that HIV treatment is working is when CD4 count is high and viral load is low.
Estimated costs for lab tests:Expect to pay around $45 per CD4 count test and $107 per viral load test.
Medication
HIV is treated withantiretroviral therapy(ART)—a combination of three or more drugs that stops the virus from multiplying and destroying CD4 cells.
You will be prescribed ART medication shortly after your diagnosis. In most cases, ART is taken every day.
This regimen may be adjusted based on your specific needs. For example, your ART regimen may be changed if you become pregnant, or if your health insurance does not cover the cost of your medications.
Estimated cost for ART:$36,000 a year
If you qualify for the state AIDS Drug Assistance Program (ADAP), you may not pay any co-payments for HIV medications, though some people who have insurance (or Medicare) will still pay some reduced co-payments. If you have Medicaid, you will typically not need to pay co-payments to receive ART.
Medical Care
Because HIV damages the immune system, people with HIV are more vulnerable to AIDS-related cancers,pneumonia,HIV-wasting syndrome, and more. These illnesses are known as opportunistic infections.
Each time you visit your doctor, you and/or your insurance provider will be billed. In addition to regular doctor’s appointments for lab tests and HIV-related checkups, you may incur more medical bills if you develop an opportunistic infection.
For this reason, the total cost of your medical bills can vary quite a bit from year to year.
Estimated cost for medical care:Between $80,000 and $113,000 after insurance or other financial aid
RecapHIV medication makes up the bulk of lifetime care expenses. Lab tests and medical visits can add up, though.
Recap
HIV medication makes up the bulk of lifetime care expenses. Lab tests and medical visits can add up, though.
Total Lifetime Cost
According to the Centers for Disease Control and Prevention, currently, the lifetime treatment cost of an HIV infection is estimated at $379,668.
Research shows that early HIV diagnosis and treatment improves health outcomes and life expectancy.
The following chart compares life expectancy and lifetime cost of care based on CD4 count at the time of diagnosis:
Note: A person is diagnosed with AIDS when their CD4 count drops below 200 CD4 cells per cubic millimeter of blood (200 cells/mm). For comparison, a healthy CD4 count for an HIV-negative person ranges between 500 and 1600 cells/mm.
Researchers in one study made several conclusions:
The results show that people diagnosed with HIV at an early stage—and who begin ART promptly—live longer and have better health outcomes. For some people, the lifetime cost can be higher due to more years taking ART.
In another study, the average lifetime cost of healthcare and treatment was $291,000 after insurance and financial aid, with ART accounting for 68% of the total cost.
Many people live with HIV for several years before they are diagnosed. In fact, an estimated 13% of people with HIV do not know they have it.
While undiagnosed people with HIV obviously don’t have ART expenses, the study found that they pay nearly as much for doctor’s appointments and emergency medical care as those who are diagnosed.
RecapThe lifetime cost of HIV medication is higher for a person who begins ART early. Undiagnosed people don’t have the burden of ART expenses, but their lifetime medical bills are still high and their health outcomes are poorer.
The lifetime cost of HIV medication is higher for a person who begins ART early. Undiagnosed people don’t have the burden of ART expenses, but their lifetime medical bills are still high and their health outcomes are poorer.
What Causes Immunosuppression?
Early Treatment, Better Outcomes
The effectiveness of healthcare and ART for an HIV-positive person depends on three main factors:
According to Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases, “We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later.”
In one study, for example, researchers followed 4,685 HIV-positive adults, all of whom began the study with a normal CD4 count above 500 cells/mm.The adults were placed in two groups: one began ART immediately, while the other group delayed ART until their CD4 counts dropped below 350 cells/mm.
After three years, researchers found that the adults who began ART immediately were 72% less likely to develop serious AIDS-related events and 57% less likely to die as a result of them.
Cost-Saving Strategies
People who cannot afford ART are far less likely to stick with it, according to the Department of Health and Human Services (DHHS). The agency urges clinicians to “minimize patients' out-of-pocket drug-related expenses whenever possible.”
If you are having trouble keeping up with the cost of your HIV-related healthcare, talk to your doctor about options.
Generic Drug Options
The U.S. Food and Drug Administration (FDA) has approved multiple generic options for each class of ART drugs. They cost less than their brand-name counterparts and are equally as effective.
The full list of generic drug options is available on the official National Health Institute website for HIV.
In some cases, switching to a generic ART regimen may increase the number of pills you have to take at a time. But it should not increase how many times per day you need to take those pills.
When discussing a generic ART regimen with your doctor, be sure to mention if having to take more pills would prevent you from sticking with your treatment. If so, a single-tablet ART may be a better option for you.
Single-Tablet ART Regimens
A single-tablet regimen (STR) combines multiple drugs into one tablet. STRs allow people with HIV to take fewer pills with each dose, making it easier and simpler to maintain their ART regimen long-term.
There is always a chance that a drug will be temporarily or permanently discontinued from the market. Or, prescriptions for each drug in an ART regimen may not be refilled at the same time. STRs solve these problems, as there is only one tablet to keep track of.
The FDA has also approved Cabenuva, a complete ART regimen that is taken via injection once per month or every other month.It combines the drugs cabotegravir and rilpivirine into one treatment, allowing it to replace a multiple-pill ART regimen.
FDA Approves First Injectable Drug for HIV Treatment
Fewer Lab Tests
To reduce lifetime cost, the DHHS recommends that doctors limit CD4 tests for people who have been on ART at least two years and have undetectable viral loads.
They state that viral load testing should be considered the primary measure of treatment success, and it should be tested every three to four months or every six months.
For people with an undetectable viral load, the DHHS also recommends that:
Even when your CD4 count and viral load are considered stable, you should see your doctor any time you developa new or worsening symptom.
AIDS Drug Assistance Programs
Patient Assistance Programs
If you are not eligible for medicare,medicaid, or ADAPs, you may apply for patient assistance programs (PAPs).
Different PAPs have different eligibility requirements, but it usually depends on your income level. To apply for a PAP, you and your healthcare professional will each fill out separate paperwork, then a caseworker will mail your application to the pharmaceutical company for consideration.
Acommon PAP form for HIVis available, and many PAP programs may accept it. Individual manufacturers may also have their own forms, so it’s worth checking their websites.
Clinical Trials
The search for ways to prevent, treat, and cure HIV is ongoing. To evaluate the safety and effectiveness of new medical approaches, drug manufacturers and researchers conduct clinical trials.
Depending on the trial, you may be able to participate. Clinical trials often offer free medication and medical care in exchange for your time and help. You may also receive money or gift cards, or be reimbursed for meals and transportation.
If you are interested in participating in clinical trials, you can contact the National Institute of Health at 1-800-448-0440, or email ContactUs@HIVinfo.NIH.gov to learn more.
Know that participating in a clinical trial may require you to take new and experimental drugs or participate in tests that can be uncomfortable. Understand going in that there may be risks involved, including unpleasant side effects. Discuss the prospect of enrolling with your doctor.
Integrative HIV Care
Research shows that HIV-positive people who receivesupportive care for mental health, substance use disorders, and sexual health may have better health outcomes and lower lifetime cost.Care programs like these are known as integrative HIV services.
Integrative careis available for HIV-positive people with substance use disorders, transgender people with HIV, older adults with HIV, and more. These services can help remove barriers to HIV care and treatment through financial assistance, counseling, and other means of support.
If you are interested in an integrative care service, talk to your doctor. Your doctor may also be able to point you toward an integrated HIV care clinic in your community.
RecapHIV care is expensive and out of reach for most people without some assistance. There are a variety of cost-saving programs and strategies that can help you reduce your lifetime cost. You may be eligible for more than you might expect, so they are worth exploring.
HIV care is expensive and out of reach for most people without some assistance. There are a variety of cost-saving programs and strategies that can help you reduce your lifetime cost. You may be eligible for more than you might expect, so they are worth exploring.
Summary
The total lifetime cost for HIV care includes doctor’s appointments, lab tests, and ART. The bulk of the cost comes from ART, but starting ART early can increase your life expectancy and improve your quality of life.
If you are concerned about the cost of your HIV treatment, talk to your doctor. With their OK, you may be able to lower your lifetime cost with generic medications, participating in a clinical trial, or other money-saving strategies.
A Word From Verywell
Living with HIV can be isolating at times, but there is no need to feel alone. Chances are there is an HIV support group online or in your community that you can join. Support groups provide opportunities to connect with people who understand what it’s like to live with HIV—from overcoming stigma to managing symptoms and dealing with money matters.
These judgment-free zones are a great place to express your concerns (financial or otherwise), ask for advice, and learn how to cope with HIV.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.HIV.gov.Symptoms of HIV.Planned Parenthood.What are the symptoms of HIV & AIDS?Cummins NW, Badley AD.Making sense of how HIV kills infected CD4 T cells: implications for HIV cure.Mol Cell Ther. 2014;2(1):20. doi:10.1186/2052-8426-2-20US Department of Veterans Affairs.CD4 count (or T-cell count).Clinical Info HIV.gov.Laboratory testing.Farnham P, Gopalappa C, Sansom S, et al.Updates of lifetime costs of care and quality-of-life estimates for HIV-infected persons in the United States.JAIDS. 2013;64(2):183-189. doi:10.1097/QAI.0b013e3182973966National Cancer Institute.Combination antiretroviral therapy.HIV Info.NIH.gov.What to start: Choosing an HIV regimen.McCann N, Horn T, Hyle E, et al.HIV antiretroviral therapy costs in the United States.JAMA. 2020;180(4):601-603. doi:10.1001/jamainternmed.2019.7108Tseng CW, Dudley RA, Chen R, Walensky RP.Medicare part D and cost-sharing for antiretroviral therapy and preexposure prophylaxis.JAMA Netw Open. 2020;3(4):e202739. doi:10.1001/jamanetworkopen.2020.2739U.S. Department of Veterans Affairs.Common opportunistic infections and HIV-related cancers.Centers for Disease Control and Prevention.HIV-cost effectiveness.HIV.gov.Lab tests and results.Nakagawa F, Miners A, Smith C, et al.Projected lifetime healthcare costs associated with HIV infection.Plos One. 2015;10(4):1-12. doi:10.1371/journal.pone.0125018National Institutes of Health.Starting antiretroviral treatment early improves outcomes for HIV-infected individuals.National Institutes of Health.Benefits of early antiretroviral therapy in HIV infection.Clinical Info HIV.gov.Cost considerations and antiretroviral therapy.Gianotti N, Poli A, Galli L, et al.Efficacy and safety of switching from branded to generic antiretrovirals in virologically suppressed HIV-infected patients.PLoS One. 2017;12(8):1-10. doi:10.1371/journal.pone.0182007GSKPro.com.Highlights of prescribing information: CABENUVA (cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension).U.S. Food and Drug Administration.FDA approves first extended-release, injectable drug regimen for adults living with HIV.Kaiser Family Foundation.The Ryan White HIV/AIDS Program: The basics.HIVinfo.NIH.gov.HIV/AIDS clinical trials.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
HIV.gov.Symptoms of HIV.Planned Parenthood.What are the symptoms of HIV & AIDS?Cummins NW, Badley AD.Making sense of how HIV kills infected CD4 T cells: implications for HIV cure.Mol Cell Ther. 2014;2(1):20. doi:10.1186/2052-8426-2-20US Department of Veterans Affairs.CD4 count (or T-cell count).Clinical Info HIV.gov.Laboratory testing.Farnham P, Gopalappa C, Sansom S, et al.Updates of lifetime costs of care and quality-of-life estimates for HIV-infected persons in the United States.JAIDS. 2013;64(2):183-189. doi:10.1097/QAI.0b013e3182973966National Cancer Institute.Combination antiretroviral therapy.HIV Info.NIH.gov.What to start: Choosing an HIV regimen.McCann N, Horn T, Hyle E, et al.HIV antiretroviral therapy costs in the United States.JAMA. 2020;180(4):601-603. doi:10.1001/jamainternmed.2019.7108Tseng CW, Dudley RA, Chen R, Walensky RP.Medicare part D and cost-sharing for antiretroviral therapy and preexposure prophylaxis.JAMA Netw Open. 2020;3(4):e202739. doi:10.1001/jamanetworkopen.2020.2739U.S. Department of Veterans Affairs.Common opportunistic infections and HIV-related cancers.Centers for Disease Control and Prevention.HIV-cost effectiveness.HIV.gov.Lab tests and results.Nakagawa F, Miners A, Smith C, et al.Projected lifetime healthcare costs associated with HIV infection.Plos One. 2015;10(4):1-12. doi:10.1371/journal.pone.0125018National Institutes of Health.Starting antiretroviral treatment early improves outcomes for HIV-infected individuals.National Institutes of Health.Benefits of early antiretroviral therapy in HIV infection.Clinical Info HIV.gov.Cost considerations and antiretroviral therapy.Gianotti N, Poli A, Galli L, et al.Efficacy and safety of switching from branded to generic antiretrovirals in virologically suppressed HIV-infected patients.PLoS One. 2017;12(8):1-10. doi:10.1371/journal.pone.0182007GSKPro.com.Highlights of prescribing information: CABENUVA (cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension).U.S. Food and Drug Administration.FDA approves first extended-release, injectable drug regimen for adults living with HIV.Kaiser Family Foundation.The Ryan White HIV/AIDS Program: The basics.HIVinfo.NIH.gov.HIV/AIDS clinical trials.
HIV.gov.Symptoms of HIV.
Planned Parenthood.What are the symptoms of HIV & AIDS?
Cummins NW, Badley AD.Making sense of how HIV kills infected CD4 T cells: implications for HIV cure.Mol Cell Ther. 2014;2(1):20. doi:10.1186/2052-8426-2-20
US Department of Veterans Affairs.CD4 count (or T-cell count).
Clinical Info HIV.gov.Laboratory testing.
Farnham P, Gopalappa C, Sansom S, et al.Updates of lifetime costs of care and quality-of-life estimates for HIV-infected persons in the United States.JAIDS. 2013;64(2):183-189. doi:10.1097/QAI.0b013e3182973966
National Cancer Institute.Combination antiretroviral therapy.
HIV Info.NIH.gov.What to start: Choosing an HIV regimen.
McCann N, Horn T, Hyle E, et al.HIV antiretroviral therapy costs in the United States.JAMA. 2020;180(4):601-603. doi:10.1001/jamainternmed.2019.7108
Tseng CW, Dudley RA, Chen R, Walensky RP.Medicare part D and cost-sharing for antiretroviral therapy and preexposure prophylaxis.JAMA Netw Open. 2020;3(4):e202739. doi:10.1001/jamanetworkopen.2020.2739
U.S. Department of Veterans Affairs.Common opportunistic infections and HIV-related cancers.
Centers for Disease Control and Prevention.HIV-cost effectiveness.
HIV.gov.Lab tests and results.
Nakagawa F, Miners A, Smith C, et al.Projected lifetime healthcare costs associated with HIV infection.Plos One. 2015;10(4):1-12. doi:10.1371/journal.pone.0125018
National Institutes of Health.Starting antiretroviral treatment early improves outcomes for HIV-infected individuals.
National Institutes of Health.Benefits of early antiretroviral therapy in HIV infection.
Clinical Info HIV.gov.Cost considerations and antiretroviral therapy.
Gianotti N, Poli A, Galli L, et al.Efficacy and safety of switching from branded to generic antiretrovirals in virologically suppressed HIV-infected patients.PLoS One. 2017;12(8):1-10. doi:10.1371/journal.pone.0182007
GSKPro.com.Highlights of prescribing information: CABENUVA (cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension).
U.S. Food and Drug Administration.FDA approves first extended-release, injectable drug regimen for adults living with HIV.
Kaiser Family Foundation.The Ryan White HIV/AIDS Program: The basics.
HIVinfo.NIH.gov.HIV/AIDS clinical trials.
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