Non-adherence to HIV treatment for cost-saving reasons reported by 8% in American study

Much of the excessive cost of prescription drugs in the United States falls on patients, and national surveillance data has now found that this has a real impact on HIV treatment outcomes. A study presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) earlier this month found that 13% of people with diagnosed HIV reported at least one cost-saving strategy, including 8% who did not always adhere to their treatment to cut costs. Rates of viral suppression and engagement in care were lower in those reporting non-adherence for economic reasons.

Dr Linda Beer of the Centers for Disease Control and Prevention (CDC) presented the study. Data came from the Medical Monitoring Project, which collects clinical and behavioural information from individuals carefully sampled to be representative of the range of people diagnosed with HIV in the United States. Interview data and medical records were available for 3650 people taking prescription drugs in 2015-2016.

Based on self-report:

  • 8% had asked their doctor for a lower-cost medication to save money
  • 1% had bought prescription drugs from another country to save money
  • 2% had used alternative therapies to save money
  • 4% had skipped medication doses to save money
  • 4% had taken less medicine to save money
  • 6% had delayed filling a prescription to save money.


virological suppression

Halting of the function or replication of a virus. In HIV, optimal viral suppression is measured as the reduction of viral load (HIV RNA) to undetectable levels and is the goal of antiretroviral therapy.

representative sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

opportunistic infection (OI)

An infection that occurs more frequently or is more severe in people with weakened immune systems, such as people with low CD4 counts, than in people with healthy immune systems. Opportunistic infections common in people with advanced HIV disease include Pneumocystis jiroveci pneumonia; Kaposi sarcoma; cryptosporidiosis; histoplasmosis; other parasitic, viral, and fungal infections; and some types of cancer. 

Ryan White HIV/AIDS Program

In the United States, the largest federally funded programme providing HIV-related services to low-income, uninsured, and underinsured people with HIV/AIDS.

Looking specifically at the last three of those strategies, they were more common in individuals with private insurance (prevalence ratio 1.76, p < 0.01), reflecting the problem of incomplete coverage and co-payments associated with private insurance. As might be expected, they were more common in individuals who had sought, but not received, help from the Ryan White AIDS Drug Assistance Program (prevalence ratio 3.88, p < 0.01). They were also more common in individuals who had a disability (prevalence ratio 1.91, p < 0.01).

Individuals reporting these cost-saving non-adherence strategies were significantly less likely to be virally suppressed (prevalence ratio 0.83, p < 0.01) or engaged in care (prevalence ratio 0.88, p < 0.01).

They were also more likely to have visited an emergency room or been hospitalised more than once.


Beer L et al. Nonadherence due to prescription drug costs among U.S. adults with HIV, 2015-2016. Conference on Retroviruses and Opportunistic Infections, Seattle, abstract 1078, 2019.

View the abstract and poster on the conference website.

Update: Following the conference presentation, this research was published in a peer-reviewed journal:

Beer L et al. Nonadherence to any prescribed medication due to costs among adults with HIV infection — United States, 2016–2017. Morbidity and Mortality Weekly Report, 68: 1129-1133, 2019.