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      What risk of death would people take to be cured of HIV and why? A survey of people living with HIV

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          Abstract

          People living with HIV (PLWHIV) can reasonably expect near-normal longevity, yet many express a willingness to assume significant risks to be cured. We surveyed 200 PLWHIV who were stable on antiretroviral therapy (ART) to quantify associations between the benefits they anticipate from a cure and their risk tolerance for curative treatments. Sixty-five per cent expected their health to improve if cured of HIV, 41% predicted the virus would stop responding to medications over the next 20 years and 54% predicted experiencing serious medication side effects in the next 20 years. Respondents’ willingness to risk death for a cure varied widely (median 10%, 75th percentile 50%). In multivariate analyses, willingness to risk death was associated with expected long-term side effects of ART, greater financial resources and being employed (all P < 0.05) but was not associated with perceptions of how their health would improve if cured.

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          US valuation of the EQ-5D health states: development and testing of the D1 valuation model.

          James W Shaw, Jeffrey A Johnson, Stephen Coons (2005)
          The EQ-5D is a brief, multiattribute, preference-based health status measure. This article describes the development of a statistical model for generating US population-based EQ-5D preference weights. A multistage probability sample was selected from the US adult civilian noninstitutional population. Respondents valued 13 of 243 EQ-5D health states using the time trade-off (TTO) method. Data for 12 states were used in econometric modeling. The TTO valuations were linearly transformed to lie on the interval [-1, 1]. Methods were investigated to account for interaction effects caused by having problems in multiple EQ-5D dimensions. Several alternative model specifications (eg, pooled least squares, random effects) also were considered. A modified split-sample approach was used to evaluate the predictive accuracy of the models. All statistical analyses took into account the clustering and disproportionate selection probabilities inherent in our sampling design. Our D1 model for the EQ-5D included ordinal terms to capture the effect of departures from perfect health as well as interaction effects. A random effects specification of the D1 model yielded a good fit for the observed TTO data, with an overall R of 0.38, a mean absolute error of 0.025, and 7 prediction errors exceeding 0.05 in absolute magnitude. The D1 model best predicts the values for observed health states. The resulting preference weight estimates represent a significant enhancement of the EQ-5D's utility for health status assessment and economic analysis in the US.
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            Full coverage for preventive medications after myocardial infarction.

            Niteesh K. Choudhry, Jerry Avorn, Robert J Glynn … (2011)
            Adherence to medications that are prescribed after myocardial infarction is poor. Eliminating out-of-pocket costs may increase adherence and improve outcomes. We enrolled patients discharged after myocardial infarction and randomly assigned their insurance-plan sponsors to full prescription coverage (1494 plan sponsors with 2845 patients) or usual prescription coverage (1486 plan sponsors with 3010 patients) for all statins, beta-blockers, angiotensin-converting-enzyme inhibitors, or angiotensin-receptor blockers. The primary outcome was the first major vascular event or revascularization. Secondary outcomes were rates of medication adherence, total major vascular events or revascularization, the first major vascular event, and health expenditures. Rates of adherence ranged from 35.9 to 49.0% in the usual-coverage group and were 4 to 6 percentage points higher in the full-coverage group (P<0.001 for all comparisons). There was no significant between-group difference in the primary outcome (17.6 per 100 person-years in the full-coverage group vs. 18.8 in the usual-coverage group; hazard ratio, 0.93; 95% confidence interval [CI], 0.82 to 1.04; P=0.21). The rates of total major vascular events or revascularization were significantly reduced in the full-coverage group (21.5 vs. 23.3; hazard ratio, 0.89; 95% CI, 0.90 to 0.99; P=0.03), as was the rate of the first major vascular event (11.0 vs. 12.8; hazard ratio, 0.86; 95% CI, 0.74 to 0.99; P=0.03). The elimination of copayments did not increase total spending ($66,008 for the full-coverage group and $71,778 for the usual-coverage group; relative spending, 0.89; 95% CI, 0.50 to 1.56; P=0.68). Patient costs were reduced for drugs and other services (relative spending, 0.74; 95% CI, 0.68 to 0.80; P<0.001). The elimination of copayments for drugs prescribed after myocardial infarction did not significantly reduce rates of the trial's primary outcome. Enhanced prescription coverage improved medication adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs. (Funded by Aetna and the Commonwealth Fund; MI FREEE ClinicalTrials.gov number, NCT00566774.).
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              Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population

              Alison J. Rodger, Rebecca Lodwick, Mauro Schechter … (2013)
              Due to the success of antiretroviral therapy (ART), it is relevant to ask whether death rates in optimally treated HIV are higher than the general population. The objective was to compare mortality rates in well controlled HIV-infected adults in the SMART and ESPRIT clinical trials with the general population. Non-IDUs aged 20-70 years from the continuous ART control arms of ESPRIT and SMART were included if the person had both low HIV plasma viral loads (≤400 copies/ml SMART, ≤500 copies/ml ESPRIT) and high CD4(+) T-cell counts (≥350 cells/μl) at any time in the past 6 months. Standardized mortality ratios (SMRs) were calculated by comparing death rates with the Human Mortality Database. Three thousand, two hundred and eighty individuals [665 (20%) women], median age 43 years, contributed 12,357 person-years of follow-up. Sixty-two deaths occurred during follow up. Commonest cause of death was cardiovascular disease (CVD) or sudden death (19, 31%), followed by non-AIDS malignancy (12, 19%). Only two deaths (3%) were AIDS-related. Mortality rate was increased compared with the general population with a CD4(+) cell count between 350 and 499 cells/μl [SMR 1.77, 95% confidence interval (CI) 1.17-2.55]. No evidence for increased mortality was seen with CD4(+) cell counts greater than 500 cells/μl (SMR 1.00, 95% CI 0.69-1.40). In HIV-infected individuals on ART, with a recent undetectable viral load, who maintained or had recovery of CD4(+) cell counts to at least 500 cells/μl, we identified no evidence for a raised risk of death compared with the general population.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Virus Erad
                Journal ID (iso-abbrev): J Virus Erad
                Journal ID (publisher-id): JOURNAL OF VIRUS ERADICATION
                Title: Journal of Virus Eradication
                Publisher: Mediscript Ltd
                ISSN (Print): 2055-6640
                ISSN (Electronic): 2055-6659
                Publication date (Electronic, collection): April 2019
                Publication date (Electronic, pub): 1 April 2019
                Volume: 5
                Issue: 2
                Pages: 109-115
                Affiliations
                [ 1 ] Duke University School of Medicine , Durham, NC, USA
                [ 2 ] Duke University Fuqua School of Business , Durham, NC, USA
                [ 3 ] Harvard TH Chan School of Public Health , Boston, MA, USA
                [ 4 ] Baylor College of Medicine , Center for Medical Ethics and Health Policy , Houston, TX, USA
                [ 5 ] Medical Practice Evaluation Center , Divisions of General Internal Medicine and Infectious Diseases , Massachusetts General Hospital , Harvard Medical School , Boston, MA, USA
                [ 6 ] Harvard Medical School , Boston, MA, USA
                [ 7 ] Division of Infectious Diseases , Brigham and Women's Hospital , Harvard Medical School , Boston, MA, USA
                [ 8 ] University of Massachusetts Medical School , Worcester, MA, USA
                [ 9 ] Population Health Sciences , Cancer Control and Population Sciences , Duke Cancer Institute , Durham, NC, USA
                [ 10 ] Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor, MI, USA
                [ 11 ] Center for Bioethics and Social Sciences in Medicine , University of Michigan School of Medicine , Ann Arbor, MI, USA
                [ 12 ] Departments of Medicine and Medical Ethics in Health Policy , University of Pennsylvania Perelman School of Medicine , Philadelphia, PA, USA
                [ 13 ] Toulouse School of Economics , University of Toulouse Capitole , Toulouse, France
                [ 14 ] Duke-Margolis Center for Health Policy , Duke University , Durham, NC, USA
                Author notes
                [* ]Corresponding author: Peter A. Ubel 100 Fuqua Drive, Durham, NC27708 Email:  peter.ubel@ 123456duke.edu
                Article
                DOI: 10.1016/s2055-6640(20)30052-2
                PMC ID: 6543487
                PubMed ID: 31191914
                SO-VID: 4b47d1a5-f823-489f-bc67-93991d753857
                Copyright © © 2019 The Authors.  Journal of Virus Eradication published by Mediscript Ltd
                License:

                This is an open access article published under the terms of a Creative Commons License.

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                Categories
                Subject: Original Research

                Keywords: hiv,medication,risk taking,treatment
                Data availability:
                Keywords: hiv, medication, risk taking, treatment

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