It’s difficult to obtain treatment for some HIV patients
Many Arizonans — our state legislators in particular — are probably unfamiliar with the phrase “U=U.” But for those at risk for and living with HIV, it is a well-known quantity.
“U=U” is short for “Undetectable equals Untransmittable.” For those living with HIV whose viral load has been reduced to the point where it is undetectable, it means that person is no longer able to transmit HIV to anyone else through sexual contact.
U=U is achievable through a class of what can truly be considered miracle drugs — and, within this class, singletablet regimens for HIV are the best option.
On Jan. 26, the Arizona Health Care Cost Containment System (AHCCCS), the body responsible for state Medicaid formulary decisions, will meet “to inform the community and gather feedback on ... upcoming AHCCCS initiatives.”
Conspicuously absent from the day’s agenda is any discussion on the need to include all single-tablet regimens (STRs) on the Arizona Medicaid formulary. It is critical that such regimens be covered for Arizonans at risk for and living with HIV, many of whom are already vulnerable and immunocompromised amid the ongoing COVID-19 pandemic.
Controlling the rate of new HIV infections is also of primary importance. Between 2014 and 2018, new HIV infections nationally dropped by 7%, in large part due to the advent of simpler, more effective therapies like single-tablet regimens.
In Arizona, however, according to the national resource AidsVu, new HIV infections have increased a staggering 22% during this same period.
Multi-tablet regimens (MTRs), the precursor to single-tablet regimens, are older and less effective but remain on state formularies because they are less expensive. They are also complicated: Multiple pills must be taken at various times throughout the day, some with food, some without, some in the morning, some at night — all while managing multiple prescriptions, refills and trips to the pharmacy.
By contrast, single-tablet regimens allow patients to achieve U=U with a single pill, taken once a day, which simplifies the treatment regimen. Typically single-tablet regimens also come with reduced or less intense side effects and lower toxicity levels.
As an HIV provider in Phoenix who cares for more than 1,300 patients each year, I have become intimately familiar with the fact that U=U is achievable for patients — but, critically, not in the same way.
Treating HIV is a remarkably complex process, and I regularly find that appropriate therapies can vary widely from patient to patient. A treatment regimen, particularly a multi-tablet regimen, that works for one individual is by no means guaranteed to work for another.
Knowing this makes the continued inaction of the AHCCCS on single-tablet regimens all the more questionable.
If I want to prescribe a single-tablet regimen to one of my HIV patients when a less effective multi-tablet regimen is an available option, I must fight tooth and nail to get an exemption.
I have personally seen the effects of older, less effective multi-tablet regimens on patients: increased bone and kidney problems are fairly common as compared with single-tablet regimens, while some actually develop drug resistance to one or more components of the drugs, making it — and any future single-tablet regimens — ineffective in managing the patient’s HIV.
If Arizona is serious about ending the HIV epidemic, it should ensure that patients and providers are equipped with every available treatment option, including and especially single-tablet regimens. Only then will providers feel empowered to work together with individual patients to determine the best course of treatment.
AHCCCS has an obligation to provide Arizona state Medicaid patients with the full range of treatment options, and to trust and empower providers to offer the best, most personalized care possible. This must begin with a discussion around including single-tablet regimens on the Arizona state Medicaid formulary.
The Jan. 26 AHCCCS meeting would be a good place to start.