Optimizing HIV care: policy implications

The introduction of highly active antiretroviral therapy (HAART) has dramatically improved clinical outcomes in patients with human immunodeficiency virus (HIV) infection. HIV infection has also become a complex chronic condition that requires a high degree of specialized clinical skills among managing clinicians. This evolving infection requires a multidisciplinary approach, which links HIV treatment with prevention and traditional healthcare screening and management. With improved immune function from HAART, non-acquired immunodeficiency syndrome-defining conditions are responsible for an increasing proportion of the morbidity and mortality experienced by HIV-infected patients. The focus of HIV care must shift from reducing short-term morbidity and mortality to maintaining long-term survival and quality-of-life goals. Reimbursement for HIV treatment is extremely low. The disconnect between treatment cost and reimbursement is not sustainable, and will become more acute as individual patient care needs begin to extend over multiple decades. Policy leaders must transition to a long-term view of HIV care and shift funding priorities to maintain a viable and engaged HIV workforce.