The lifetime cost of current human immunodeficiency virus care in the United States

Med Care. 2006 Nov;44(11):990-7. doi: 10.1097/01.mlr.0000228021.89490.2a.


Objective: We sought to project the lifetime cost of medical care for human immunodefiency virus (HIV)-infected adults using current antiretroviral therapy (ART) standards.

Methods: Medical visits and hospitalizations for any reason were from the HIV Research Network, a consortium of high-volume HIV primary care sites. HIV treatment drug regimen efficacies were from clinical guidelines and published sources; data on other drugs used were not available. In a computer simulation model, we projected HIV medical care costs in 2004 U.S. dollars.

Results: From the time of entering HIV care, per person projected life expectancy is 24.2 years, discounted lifetime cost is Dollars 385,200, and undiscounted cost is Dollars 618,900 for adults who initiate ART with CD4 cell count < 350/microL. Seventy-three percent of the cost is antiretroviral medications, 13% inpatient care, 9% outpatient care, and 5% other HIV-related medications and laboratory costs. For patients who initiate ART with CD4 cell count < 200/microL, projected life expectancy is 22.5 years, discounted lifetime cost is Dollars 354,100 and undiscounted cost is Dollars 567,000. Results are sensitive to drug manufacturers' discounts, ART efficacy, and use of enfuvirtide for salvage. If costs are discounted to the time of infection, the discounted lifetime cost is Dollars 303,100.

Conclusions: Effective ART regimens have substantially improved survival and have increased the lifetime cost of HIV-related medical care in the U.S.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / economics
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Acquired Immunodeficiency Syndrome / economics
  • Acquired Immunodeficiency Syndrome / mortality
  • Acquired Immunodeficiency Syndrome / prevention & control
  • Adult
  • Anti-Retroviral Agents / economics*
  • Anti-Retroviral Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Clinical Trials as Topic
  • Cohort Studies
  • Computer Simulation
  • Cost-Benefit Analysis
  • Enfuvirtide
  • Female
  • Forecasting
  • HIV Envelope Protein gp41 / economics
  • HIV Envelope Protein gp41 / therapeutic use
  • HIV Fusion Inhibitors / economics
  • HIV Fusion Inhibitors / therapeutic use
  • HIV Infections / drug therapy
  • HIV Infections / economics*
  • HIV Infections / mortality
  • HIV Infections / prevention & control
  • HIV-1 / genetics
  • Health Care Costs / statistics & numerical data*
  • Health Services / economics
  • Health Services / statistics & numerical data
  • Hospitalization / economics
  • Humans
  • Inpatients
  • Life Expectancy
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Outpatients
  • Peptide Fragments / economics
  • Peptide Fragments / therapeutic use
  • Practice Guidelines as Topic
  • Primary Health Care
  • RNA, Viral / analysis
  • Time Factors
  • United States


  • Anti-Retroviral Agents
  • HIV Envelope Protein gp41
  • HIV Fusion Inhibitors
  • Peptide Fragments
  • RNA, Viral
  • Enfuvirtide