HCV in HIV-Coinfection: ADAP, Access, Treatment Costs
Reported by Jules Levin
Download the PDF ADAP|
In Clinical Infectious Diseases (Aug 2002; 35: 606-610) Walensky, Freedberg
and Paltiel discuss the shortcomings and problems associated with our ADAPs
(AIDS Drug Assistance Programs). As part of this article the authors discuss
HCV and the implications of care and treatment as it relates to ADAP and
finding a way to make treatment accessible to coinfected patients without
medicaid or private insurance. The full text of the article is available
right here for download in pdf.
Emerging infections: hepatitis C. A new public health crisis threatens to
send the (health care for HIV) system into further disarray. The story of the
emergence of hepatitis C virus infection in many ways mirrors the HIV story,
albeit 15 years later. First, there is a large and growing hepatitis C
prevalence. Hepatitis C is already the most common chronic bloodborne
infection in the United States, affecting at least 2.7 million people and
accounting for 25,000 deaths annually. Second, a substantial number of people
with hepatitis C infection remain unaware they are infected and continue to
transmit the virus to others. Third, hepatitis C infection has a long,
clinically silent period followed by considerable morbidity, mortality, and
cost. Unlike HIV infection, however, liver transplantation further increases
the cost of care for advanced hepatitis C infection. Hepatitis C infection is
now the leading reason for liver transplantation nationally, accounting for
30% of all transplantation procedures (1000 patients per year).
In 1997, the estimated total costs of medical treatment and lost work in the
United States attributable to hepatitis C infection, including costs
attributable to transplantation, primary liver cancer, and chronic liver
disease, exceeded $5 billion. Finally, new and effective hepatitis C therapy
carries substantial costs that cannot possibly be borne by uninsured
patients. The hepatitis C nucleoside analogue, ribavirin, for example, has an
average wholesale cost of $1100 per month, which is 3 times greater than the
cost of the most expensive HIV nucleoside analogue. Treatment with IFN- also
costs $500$1000 per month. Thus, combination medical therapy for hepatitis C
infection carries a higher annual cost than does HIV therapy, even if the
transplantation costs of >$200,000 per patient are ignored.
As treatment for hepatitis C infection increasingly becomes standard, a need
will emerge either for ADAP-like programs for hepatitis C infection to be
instituted or for existing ADAPs to expand coverage for hepatitis C therapy.
The challenge for infectious diseases physicians and public policy makers is
to tackle the current inequalities, limitations, and budget constraints of
ADAPs before they are further exacerbated by the hepatitis C epidemic.