What does HIV/AIDS cost? The answer to this question depends a lot on whom you ask.

Ask the UN and you’ll get the staggering sum of $10 billion. A year . The annual per capita cost of treating infected Africans, where much of the UN money goes, is around $1,100. One of the major problems facing HIV/AIDS advocates is their inability to lower this number. An estimated $600 is spent on anti-retroviral drugs, while the remaining $500 is spent on other AIDS associated conditions. Even $10 billion wouldn’t cover treatment for the more than 20 million Africans with HIV/AIDS. A considerable portion of the proposed UN budget is directed not towards treatment but towards prevention. A major problem is that no one can seem to agree on the actual cost. Although the UN has held firm to their estimate, other groups have presented vastly different figures. The World Health Organization has presented four different scenarios which vary wildly in both the projected outcome and cost. To merely maintain the current status quo, WHO estimates more than $400 billion will need to be spent over the next 20 years. To significantly reduce annual new HIV infections, WHO’s figure is more than $700 billion. Unfortunately such different figures can sometimes complicate funding by making it hard for donors to decide how much to give.

Ask someone who is living with HIV/AIDS and you’ll get a number that’s a lot smaller. The average AIDS patient in America takes a combination of drugs that add up to around $14,000 a year . Much of this cost in the US is defrayed by private insurance, government insurance or sometimes through AIDS drug assistance programs (ADAPs) . These programs are meant to provide access to drugs for low income individuals. Currently 89% of people enrolled in ADAPs make less than 300% of the federal poverty level. However recently the economic conditions have forced many states to scale back their support of these programs. States have either closed enrollment entirely, or narrowed eligibility-forcing people to drop out. Currently the nationwide waiting list is at an all time high of 3,586 people .



Ask the companies that manufacture these lifesaving drugs and you’ll be back to huge figures. One of the newest drugs to enter the market, Fuzeon , is produced by the giant Swiss company, Roche. Roche maintains that Fuzeon’s price (nearly $20,000 a year, or three times the next most expensive drug) is due to the $600 million cost of development. The average drug begins to turn a profit in 16 years, but analysts estimate that Fuzeon’s pricing, and anticipated demand, could mean profits for Roche in as little as three years.

Ask an economist and you’ll get a couple different figures. By 1995 more than $75 billion had been spent on AIDS. Since then, spending has increased most years, with an average of $10 billion more being spent every year. But money spent directly on AIDS does not even begin to cover the true cost. In addition, economists have tried to measure the costs related to lost productivity, wages, and premature death, due to the disease. Figures vary, but some think that indirect costs account for nearly 80 percent of the total cost of AIDS. Worst case scenario guesses estimate that AIDS robs the world of 1.4% of gross domestic product, or the equivalent of wiping out the economy of Australia .



A government study in Uganda found that some companies are hiring and training two employees for a single job in the hope that one will stay healthy. The UN estimates that since 1981 AIDS has reduced Africa’s overall labor force by 25%. Sick days and absenteeism due to AIDS related illness have further reduced productivity in the countries hit hardest by AIDS.

Ultimately the cost of HIV/AIDS is extraordinarily difficult to measure. The disease affects so many people worldwide that it would be impossible to assess the impact that it has had on everyone. However it is obvious that unless something drastic changes, the costs will continue to grow until they become unbearable.

VIRIP: A new anti-HIV compound?

Welcome to this installment of The AIDS Pandemic. I’m Dave Wessner.

Could our own bodies be producing potent inhibitors of HIV? According to research published in today’s issue of Cell, the answer may be ‘Yes.’ And these interesting findings eventually may lead to the development of new anti-retroviral drugs.

Since the isolation of HIV in 1983, numerous naturally occurring human factors have been postulated to have anti-HIV properties. Today, a group of researchers in Germany have added another factor to this list. By studying hundreds of small molecules isolated from human blood, the researchers identified a short peptide, or protein fragment, that effectively blocked HIV from infecting cells. Termed Virus-Inhibitory Peptide, or VIRIP, this peptide represents a small piece of a larger protein normally found in our blood – alpha1-anti-trypsin.

To demonstrate the inhibitory effects of VIRIP, the researchers infected cell lines with HIV-1, added VIRIP to the cells, and then determined how many additional cells subsequently became infected. VIRIP decreased the infection rate in a dose-dependent manner. In other words, when higher concentrations of VIRIP were used, the effect was greater. The effect also was very specific for HIV; the peptide did not block the infectivity of other types of viruses. Interestingly, the researchers showed that if they altered the VIRIP peptide slightly, it’s inhibitory properties increased dramatically. Finally, VIRIP was equally effective against strains of HIV that were resistant to other anti-retroviral drugs, yet resistance to VIRIP was not observed.

Mechanistically, it appears that VIRIP blocks HIV infection by binding to the viral protein gp41 and preventing fusion between the viral envelope and the cell membrane. An existing drug, T20, or Fuzeon, works in a similar manner.

The path from an initial discovery like this and a marketable drug is a long and winding path, filled with potholes. Promising candidate molecules rarely become FDA-approved drugs. So, the odds are against VIRIP. But, based on this report, it’s certainly worth keeping our eye on it.

Until next time, I’m Dave Wessner.