The cost of success.

A U.S. adult entering HIV care with a CD4 cell count of less than 350 has a life expectancy of about 24 years, according to an analysis based on data from a consortium of primary care sites with large HIV caseloads. (1) The discounted lifetime cost of care is $385,000, and the undiscounted cost is $619,000; antiretroviral drugs account for 73% of the undiscounted cost. By comparison, in the early 1990s, HIV-infected adults with a CD4 cell count of 500 had a life expectancy of about seven years, care over their lifetime cost about $119,000 ($150,000 in discounted dollars) and about half of that cost went to pay for hospitalization stays. Under a range of assumptions about drug costs, the efficacy of therapy and the availability of a fusion inhibitor (a drug that prevents HIV from entering healthy cells), the current estimated life expectancy varied from 21 to 25 years, and discounted lifetime cost varied from about $330,000 to $400,000. Over the long term, the estimated 40,000 HIV infections detected in the United States each year will lead to some $12.1 billion annually in medical costs. The analysts call for "greater investments in evidence-based HIV prevention activities ... matched by the commitment of sufficient resources to HIV medical care so that persons living with HIV today can fulfill the expectation that they will live long and healthy lives."

(1.) Schackman BR et al., The lifetime cost of current human immunodeficiency virus care in the United States, Medical Care, 2006, 44(11):990-997.

FYI is compiled and written by Dore Hollander, executive editor of Perspectives on Sexual and Reproductive Health.