The Centers for Disease Control and Prevention, US, considers HIV infected persons who have CD4 counts below 200 cells/mm3 to have AIDS, regardless of their signs or symptoms. These tests are repeated about two-to-eight weeks after starting or changing anti-HIV therapy. If HAART is maintained, then tests are repeated every three-to-four months.

Challenge 3: Cost of HIV prevention programs and HAART in Malaysia

Majority of HIV prevention programs are funded by the government in Malaysia. The primary aim of anti retrovial therapy (ART) is the prevention of the mortality and morbidity associated with chronic HIV infection at low cost of drug toxicity. Treatment should improve the physical and psychological well being of people living with HIV infection. The secondary aim of treatment is reduction of sexual transmission of HIV infections. The revision of treatment protocols for HAART initiation for individuals with primary HIV infection and CD4 count of less than 350 cells/mm3 have drastically increased the cost of ART.

The total reported expenditure in 2009 in the Asia Pacific was about $1.07 billion. Total needs for an effective response in Asia and the Pacific are estimated to be about three times the current expenditure levels. In UK, the estimated annual ART costs have increased from £104 million in 1997 to £483 million in 2006 with a projected annual cost of £721 million in 2013. In the US, the federal budget request in 2011 was $20.4 billion for domestic HIV/AIDS program. Americans diagnosed with the AIDS virus are expected to live for an average of about 24 years. The cost of healthcare for 24 years is more than $600,000. It will increase in the future due to increasing cost of production of antiretrovial drugs used in ART programs.

At a cost of $10,000-15,000 per person-per year, the antiretroviral drugs were too expensive for the majority of HIV infected people in developing and poor countries. In 2001, an Indian pharmaceutical company started to produce generic antiretrovirals that were exactly the same as those made by large pharmaceutical companies, but significantly cheaper at $295 per person-per year. This price war between branded and generic drug makers forced the large pharmaceutical companies to lower the price of their AIDS drugs.

In 2009, the most commonly used second-line regime (lamivudine+tenofovir+ritonavir-boosted lopinavir) was $554 in low-income countries, $692 in lower-middle-income countries and $601 in upper-middle-income countries per person-per year. It is the greatest challenge for the governments to reduce annual costs on ART without affecting the current high standards of care and treatment outcomes. A collaborative and robust multi-technological approach is required to increase diagnostic accuracy of HIV tests, to reduce the cost of PCR diagnostics and to sustain high levels of funding for ARV treatment coverage. Domestic AIDS prevention funding must be combined with well-funded public health insurance and protection mechanisms to cover essential HIV and AIDS services.