Reference no: EM132254688
When, in the summer of 1996, reports were released on the success of protease inhibitors in treating AIDS, both the government and clinical directors were faced with new problems of distribution. Protease inhibitors were used as part of a drug cocktail that can drive the HIV virus below the level of detection and lead to a great increase in disease-fighting immune cells. But no one knew if the drugs could wipe out HIV lurking in the lymph nodes. Indeed, little had been published. Attention had been focused on dramatic turnabouts, but less attention had been paid to failures, or resurgences of the virus. Since that time many more effective and costly drugs have been produced that are prescribed usually in combination. To date, these treatments have never been proven curative.
Treatments developed would cost between $10,000 and $20,000 year at retail. The exact price would depend on the other drugs used in the cocktail. Although most private health insurance and managed care programs cover the treatment, some are restricting its use to the advanced stages of the disease. The decision to treat is usually based upon laboratory tests that show the depression in the immune system (CD4) and the amount of virus present (viral load). Indeed, there is debate as to when it is best to begin treatment with the newer cocktails. Early treatment might make HIV cells drug-resistant and leave the patient with no drugs when the virus re-emerges. Waiting for even the first symptoms to appear might take five to ten years, making clinical trials difficult.
Even today many infected individuals have no insurance or are under- insured. Clinical directors estimated that they would have to double their income in order to meet the demand for the new treatments. National estimates put the total cost of treating HIV in the billions, with the average total cost of HIV care being near $20,000 per patient per year. There are, moreover, problems with the treatment. The patient must many per day on a very tight schedule along with dietary restrictions. In most cases the treatment will last for the rest of the patient's life. There is serious doubt about the ability of drug users, alcohol abusers, and many rootless people to maintain such a regime. This fear is reinforced by the side effects of some of the cocktails: nausea and headaches at the start of treatment. These effects cause some to stop treatment. If the patient starts and then stops, there may be serious social consequences. Specifically, a new drug-resistant form of HIV may develop and spread through the population. Already there are cases of patients who have sold their protease inhibitors in order to purchase street drugs. Newel, once-daily regimens offer a greater likelihood of compliance, but the issue remains. Even aside from the discipline required for the treatment, should the government increase payment for these new antivirals? What health care services or general public services should be reduced to provide this extra money? This is a political and social question that involves the opinion of the whole society.
Should clinic directors refuse to treat those who do not appear to have the discipline to carry through with treatment? If they do treat them, how can they justify the risk of producing new drug-resistant strains of HIV? How are the answers to these questions affected if the clinics receive no new funding?