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Advances in health and medicine.
Marjorie Bekaert Thomas
Advances in health and medicine.
General Health Channel
Reported January 15, 2013

HIV Treatment: A Costly Compromise?


(Ivanhoe Newswire) – The management of HIV has improved so much in the past few years that now people can take a single pill containing three different antiretroviral drugs to manage the disease. The production of generic versions of these antiretrovirals may even save one billion dollars, but at what cost to efficacy? 
HIV treatments can be expensive, especially for the United States Health Care System. Of the estimated nine billion dollars spent on antiretroviral drugs in 2011, most was paid for by government sources. 
Now that generic versions of two of the antiretroviral drugs found in the pill Atripla, which contains three and patients can take once a day, will soon be available many wonder what the benefits and problems would be switching to the generics. 
The study attempts to find a possible answer to this question by using a mathematical model of HIV progression to imitate the outcomes of taking a daily three-pill regimen of generic efavirenz and lamivudine plus brand-name tenofovir. Researchers also used the model to simulate the effects of taking the single pill Atripla for comparison purposes. 
Researchers found that although the three pill regimen could result in savings of $42,500 over a patient’s lifetime, a one billion dollar savings each year, life expectancy could also be lowered by as much as four and a half months. 
"For patients who take their medications well and adhere to the medical regimen, the generic option will be a bit more complex but could be as effective as the standard regimen,” lead study author Rochelle Walensky, M.D., M.P.H., from the MGH Medical Practice Evaluation Center was quoted as saying.
However, Walensky warns that the generic drugs may not be a good idea for all patients.
“A patient who relies heavily on the simplicity of taking a single pill is more likely to suffer detrimental effects, since missing doses will increase the risk of treatment failure,” Dr. Walensky was quoted as saying.
The fact that this could be a less effective treatment for some people with HIV will put doctors in a difficult situation of whether they should recommend the generics in order to save money, possibly at the cost of certain patients’ health.
"This is a trade-off that many of us will find emotionally difficult, and perhaps even ethically impossible, to recommend,” Dr. Walensky was quoted as saying. 
Source: Annals of Internal Medicine, 15 January 2013
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