2010 & Beyond
BY Benjamin Ryan
November 18 2010 5:00 AM ET
Keith Alcorn of London-based AIDS organization NAM predicts that by 2020 HIVers will be able to monitor their own viral load and CD4-cell levels at home and then report back electronically to their physician. This will mean fewer doctor visits and move the self-management of HIV closer to that of diabetes patients checking their glucose levels.
He also says affordable at-home rapid antibody tests should be widely available. Unfortunately, though, the “window period,” when someone is infected with the virus but hasn’t yet developed the antibodies that will lead to a positive test, will remain a problem. People testing themselves within this approximately six-week time frame won’t be able to get a completely accurate read from a home viral-load test either, Alcorn believes, since those tests have a wide margin of error when detecting low levels of the virus.
Normal Life Expectancy
Brian Risley, a treatment educator at AIDS Project Los Angeles, predicts that HIVers will eventually have a normal life expectancy, thanks to improved treatments and better understanding of when to begin antiretroviral therapy. He points to a recent European study that found “near normal” survival for HIVers who kept their T-cell count above 500 for three years or more.
There are few options for permanently reversing the effects of lipodystrophy -- the redistribution of fat throughout the body that is a side effect of some anti-HIV medications -- outside of expensive, temporary facial fillers. The FDA is on the verge of approving a drug called tesamorelin, which has been shown to cut deep belly fat deposits -- a.k.a. “Crix belly” -- by an average of 18%. APLA’s Risley sees a time not far off when scientists will better understand the causes of lipodystrophy and can then reverse the condition through the use of statin and glucose-regulating drugs.
Health Care Reform
Today, three in 10 HIVers are uninsured. Forty-five percent have an income of less than $10,000, and 62% are unemployed. More than half receive health coverage through Medicaid or Medicare. Considering this portrait of the population, the passage of health care reform promises big changes for HIVers as the legislation is rolled out between now and its full implementation in 2014.
Robert Greenwald, director of the Health Law and Policy Clinic at Harvard Law School, applauds the bill. “While I certainly have some concerns and disappointments,” he says, “there is no question that this health care reform bill represents a significant step forward in meeting the care and treatment needs of many, many people living with HIV.”
Some of the major benefits this year:
>The infamous medication “doughnut hole” gap, during which beneficiaries have to pay out of pocket for prescriptions under the Medicare Part D prescription drug benefit, will phase out by 2020. Starting this year, the government will provide a $250 rebate. In 2011 brand name drugs will be 50% off, but their full price will still count toward the total doughnut-hole expenditures, potentially cutting out-of-pocket costs in half. AIDS Drug Assistance Program coverage will also count toward the doughnut hole.
>Temporary high-risk insurance pools will provide health insurance to people who have been shut out of coverage because of preexisting conditions for six months or longer.
>If you are 26 or under, you can still qualify for coverage under your parents’ health plan.
>New insurance policies must provide coverage for annual checkups and preventive care, like cancer screenings.
>Lifetime benefit caps will end.
Some of the major benefits by 2014:
>All Americans must obtain insurance coverage.
>Anyone with an income of 133% or less of the federal poverty level will qualify for Medicaid (currently $14,403 for an individual or $29,326 for a family of four). A disability diagnosis (an AIDS diagnosis counts as one; an HIV diagnosis doesn’t) will no longer be necessary.
>Underwriting and preexisting condition exclusions will end; insurers may not reject you or charge you a higher premium based on your health status.
>Government subsidies will help with premium costs for people with incomes up to four times the federal poverty level ($43,320 for an individual or $88,200 for a family of four).
>Plans will have to provide coverage for mental-health and substance-abuse treatment.
>Insurance exchanges will pool risk, allowing for more affordable individual or small-business health policies. This will reduce the likelihood of workplace discrimination based on HIV status if an employer is concerned an HIVer’s medical bills may drive up premiums.
>HIVers will have more flexibility in where they live and how they work, since the availability and affordability of health benefits will no longer depend entirely on an employer’s benefits package or a certain state’s public-assistance budget.
However, there is a major drawback to health reform plan. By 2019, there will still likely be 23 million uninsured Americans, one third of whom will be undocumented immigrants. The rest will likely be members of hard-to-reach populations -- for example, the homeless -- who have not gotten themselves into the system. Depending on the political climate as the decade unfolds, the undocumented population may find itself increasingly squeezed out even from Ryan White Act sources of medical funding.