OBJECTIVES: For more than three decades the world has been facing the global challenge of tackling the HIV epidemic. The objective of this study was to conduct comparative analysis of different therapeutic groups of drugs intended for treatment of HIV / AIDS, according to the recommendations of the European AIDS Clinical Society (EACS) and their availability in the United Kingdom, Germany, France, Italy, Spain and Bulgaria, to compare the levels of these indicators in Bulgaria and to make a reasonable assumption about the degree of coverage of the needs of Bulgarian patients for innovative treatment, guaranteeing survival and good quality of life.

METHODS: Comparison of the pricing and reimbursement policies, the role of the health technology assessment (HTA) and measurement of the compliance and availability indexes of all considered markets.

RESULTS: Access to Antiretroviral treatment across Europe’s Big 5 and Bulgaria was generally provided to a high standard, although time to initiation may vary. HTA was mandatory in Bulgaria, while in the other considered markets HTA requirements differed or were not compulsory due to major influence of the local HIV societies. Compliance and availability indexes’ value revealed Bulgarian patients were treated with novel therapies in line with the recommendations of the EACS guidelines, however the country fell in the middle of the range with reimbursed HIV medicines authorized by EMA.

CONCLUSION: In the beginning of 2021, Bulgaria was the only country without a national program for prevention and control of HIV infections and the only one where pre-exposure prophylaxis (PrEP) was not introduced. Testing rate, percentage of diagnosed people treated with ARTs and share of viral suppression among treated people were areas for improvement where execution level was far behind Europe’s Big 5 and a lot more efforts need to be invested to put the country on an equal footing.