Antiretroviral drugs stop HIV transmission, study shows — but can people afford them?
The risk of passing on the HIV virus is completely eliminated by antiretroviral drugs, a landmark study found, meaning the global pandemic that has killed nearly 35.4 million people may have an end in sight.
The study, published in the Lancet on Thursday, followed 1,000 gay male couples who had sex without a condom over a course of eight years. For each couple, one of the partners had HIV and was taking antiretroviral drugs to suppress it.
After the study was finished the researchers found no one contracted HIV from their partner, raising hopes that the drugs could eventually end new infections.
But antiretrovirals can be expensive and people living with HIV may feel a range of financial burdens to try to get the needed medications, according to experts.
For example, the price for combination treatments can reach around $15,000 a year in Canada. But many provinces offer full or partial coverage of antiretrovirals.
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“Affordability is still a huge issue, especially in richer countries where the drugs are higher in price. But on the other hand, these rich nations have well-funded insurance and government plans,” Peter Godfrey-Faussett, science adviser at UNAIDS, said.
He added that there has been enormous work over the past decades to try to lower the cost of antiretroviral drugs.
“Many companies have given up their intellectual property so their patents go to generic companies, who can manufacture the drugs for less money,” Godfrey-Faussett explained.
Antiretroviral drugs affordability in Canada
There were an estimated 63,110 Canadians with HIV in 2016, with 2,165 new infections that year (latest government numbers).
Canada does not have a national plan for universal coverage for antiretroviral drugs, therefore, it’s up to the provinces.
“[Antiretroviral] drugs are expensive, depending on where you live in Canada you may have to pay a lot of money for combination therapy,” Dr. Aslam Anis, director of the Centre for Health Evaluation and Outcome Sciences, said.
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Six out of the 13 provinces and territories offer universal coverage for antiretroviral drugs, according to a 2017 study published in CMAJ.
British Columbia, Alberta, Northwest Territories, Nunavut, and Prince Edward Island offer universal coverage of antiretrovirals for all of their residents living with HIV. In New Brunswick, because premiums and co-payments are waived and not collected, the plan functions as a universal one.
Other regions have either a co-payment or a deductible, or both, for antiretrovirals.
In provinces and territories where drugs are not universally covered, the 2017 study said patients can spend anywhere from $45 to $7,993 per year, depending on income and age (the patients, in this case, did not private drug insurance and were not eligible for publicly funded drug coverage, the authors noted).
For example, although Ontario does not have universal coverage for some HIV/AIDS drugs, there are several programs offered, such as the Trillium Drug Program, which helps residents who do not have private insurance cover the costs of their needed medicine. But residents have to pay a deductible, which is around four per cent of their total household income.
People who fall in the low-income or unemployed bracket will have a very low deductible. But as you earn more money, your deductible goes up.
Sean Hosein, science and medicine editor and co-founder of CATIE, said although the cost of antiretroviral drugs is not a huge barrier for many Canadians, ideally, it would be great if the medicine was universally covered across Canada.
“It would be great if people did not have to pay a premium [or deductible], it would simplify things even more,” he said.
Despite the price, Hosein said an important takeaway from Thursday’s study is that there are still many programs to help subsidize the cost and it’s important for Canadians to go get tested as antiretroviral drugs will help a person lead a healthy life.
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Access still a difficulty
Anis said one of the biggest barriers for people living with HIV/AIDS in Canada is access.
“People are not accessing care because they are undiagnosed, so the problem is testing. And there are people who are diagnosed who are not getting treated because of access to treatment,” he said.
For example, he said if you go get tested for HIV, you need an address for health professionals to contact you.
“But if you are homeless you don’t have an address, so accessing care is not possible.”
What about pricing in developing nations?
Around 37 million people around the world are infected with HIV, according to UNAIDS. Approximately 67 per cent lived in sub-Saharan Africa.
Although life expectancy in the region has greatly improved due to antiretroviral drugs, the coverage remains “suboptimal” and HIV remains high, according to a 2017study published in NCBI.
Godfrey-Faussett with UNAIDS, said life expectancy in the region has greatly improved due to antiretroviral drugs. And due to the efforts of foundations and donations from other countries, the cost of one specific generic HIV/AIDS drug is now sold to low-and-middle income countries at around US$75 per person, per year.
“Drug prices have come down a lot,” he said. “$75 a year for one particular pill is what it costs for the standard treatment. But some people still may require a more expensive second or third option.”
Hosein said a big problem in sub-Saharan Africa is also access to the drugs.
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“There are a lot of poor people who live in rural areas who don’t have access to clinics,” he said. “Access needs to be dealt with.”
“But the news of the study is wonderful and will intensify momentum to get everyone on treatment who needs it,” he said.
He said he believes the findings of Thursday’s study will “reenergize” the HIV/AIDS movement and more donor funding will hopefully come in.
“Then I think we may be able to get HIV/AIDS in control.”
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