title: Optimizing HIV treatment.
abstract: OBJECTIVE
  There are at least seven million people eligible for antiretroviral treatment but not receiving it. An additional 19 million people will need to start treatment in the future, as their HIV disease progresses. Funding for Universal Access to HIV treatment has been restricted by the Global Financial Crisis.
  
  
  RESULTS
  There are three large randomized trials ongoing, designed to establish the efficacy of lower than approved doses of antiretrovirals. If successful, the results of these trials could lower costs of antiretrovirals and improve the safety profiles. Clinical trials evaluating efavirenz, atazanavir, ritonavir and stavudine are discussed. The costs of these and other antiretrovirals are presented.
  
  
  CONCLUSIONS
  The results of these trials could significantly lower the costs of Universal Access. Assuming 15 million people on antiretroviral treatment, the reduction in unit costs of tenofovir (TDF)/3TC/efavirenz from dose optimization of efavirenz to 400 mg once daily would save US$16 per person, leading to an overall saving of US$192 million per year. The switch from zidovudine (ZDV)/3TC/atazanavir (ATV)/r 300/100 once daily to dolutegravir along with ATV/r 200/50 once daily would save US$267 per person, leading to an overall saving of US$801 million. The combined saving in costs from first- and second-line treatment would therefore be US$993 million per year.
authors.affiliation: Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK. microhaart@aol.com
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics; D003365:Costs and Cost Analysis; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D019428:HIV Integrase Inhibitors / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D009705:Nucleosides / Q000008:administration & dosage / Q000191:economics; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000191:economics
chemical_list: D019380:Anti-HIV Agents; D019428:HIV Integrase Inhibitors; D009705:Nucleosides; D011480:Protease Inhibitors