OBJECTIVES: HIV infection becomes a chronic and manageable disease with life-long treatment. However, late presentation of HIV with opportunistic infections (OIs) remains an important issue and its burden to Taiwan’s healthcare system has not been established. This study aims to provide estimates of direct medical costs associated with OIs in HIV-infected patients from Taiwan’s National Health Insurance (NHI) perspective.

METHODS: A longitudinal HIV cohort extracted from Taiwan’s NHI Research Database 2001-2011 was utilized, where 12,457 patients with a total of 59,083 person-years of follow-up were analysed. Direct medical costs for inpatient and outpatient care among the patients with at least 3 years of follow-up were assessed. The medical costs associated with OIs were calculated and adjusted using a generalized estimating equation model. The patients were stratified according to the medication possession ratio (MPR) of antiretroviral therapy (ART), with MPR≥0.8 as good adherence. Costs were presented in 2016 United States dollars.

RESULTS: The annual medical costs for male HIV-infected aged between 25-34 with no complications and comorbidities were $1,522 (baseline costs), whereas that for the patients with MPR<0.1, 0.1≤MPR<0.8 and MPR≥0.8 were $458.5, $5,731, and $9,375.9, respectively. The OIs were significantly associated with increased medical costs, with non-Hodgkin’s lymphoma as the most expensive (4.78 fold of baseline costs) and herpes zoster as the least expensive (1.22 fold of baseline costs). The extent to which medical costs increased due to OIs among the patients with good adherence to ART is less prominent, compared to that among those with poor adherence.

CONCLUSIONS: OIs can lead to a considerable economic burden in the care of HIV-infected patients, which however might be mitigated by good adherence to ART. The development of preventive and treatment strategies for these complications is critically needed.