An ongoing dialogue on HIV/AIDS, infectious diseases,
March 10th, 2009
Unwelcome Visitor: Cost of HIV Meds
Those of us who practice HIV medicine in Taxachusetts (warning, click link at your peril) live a pretty charmed life, at least so far as getting HIV medications paid for. Due to an incredibly generous AIDS Drug Assistance Program (ADAP), rare is the patient who faces financial barriers getting his or her drugs.
(By the way, we abbreviate it “HDAP” here, not ADAP. And we treat early syphilis with two shots of penicillin, not one. And we voted for McGovern. And we drive on the left.)
But the recent downturn in the economy has changed this usually comfortable situation in the Bay State.
A patient of mine called to tell me that his co-pay for a 3 month supply of his antivirals is now nearly $2000. Another one has simply stopped coming to appointments, as his wife’s insurance has such a large deductible that he will only agree to blood tests, not an actual office visit. A third asked me whether he would be better off stopping enoxaparin or his HIV meds, since he couldn’t afford both.
I am sure things are much worse in other States — after all, Houston’s Joe Gathe initially tried lopinavir/r monotherapy since he reasoned that some ART was better than none, and his patients couldn’t afford triple-therapy.
Where is this headed? It’s tough to make predictions (especially about the future), but I suspect that when 3TC and saquinavir become generic, we might be turning to them more often than we’d previously thought.
Paul E. Sax, MD
Associate Editor
NEJM Clinician
Biography | Disclosures & Summaries
Learn more about HIV and ID Observations.
FROM NEJM — Recent Infectious Disease Articles- Postpartum Persistence of Ebola Virus in Breast Milk March 12, 2026To control EBOV outbreaks, defining potential sanctuary sites where the virus may persist and lead to transmission is important. In this report, persistence of EBOV RNA in breast milk was identified and characterized.
- Soft Tick Relapsing Fever March 12, 2026A 74-year-old man was admitted to the hospital with a 3-week history of intermittent fevers, muscle aches, and vomiting. Thin blood smears showed spirochetes.
- Case 8-2026: A 57-Year-Old Woman with Chest Pain, Dyspnea, and Syncope March 12, 2026A 57-year-old woman was evaluated because of 2 days of chest pain and dyspnea. Ultrasonography showed a pericardial effusion with diastolic inversion of the right ventricle. A diagnosis was made.
- Massive Intravascular Hemolysis from Clostridium perfringens Bacteremia March 12, 2026A 73-year-old woman presented in shock with a 1-day history of malaise, dyspnea, and confusion. Serum samples could not be processed owing to gross hemolysis. Dehemoglobinized red cells and bacilli were seen on a peripheral-blood smear.
- The Eyes Have It March 5, 2026A 47-year-old man was brought to the ED by EMS after being found dyspneic in his car. He reported having been drinking for 6 hours before presentation. He noted a sensation of tongue swelling and difficulty breathing.
- Postpartum Persistence of Ebola Virus in Breast Milk March 12, 2026