An HIV diagnosis can be a bitter pill to swallow. And so are most HIV treatments. To improve treatment adhesion, existing drug Dolutegravir will soon come in a strawberry-flavored, dissolvable tablet.
This news is groundbreaking for children and infants living with HIV. The World Health Organization (WHO) reports more than 160,000 new cases of HIV in children every year. Most of these children are infected at birth or through breastfeeding.
Traditionally, children with HIV are difficult to treat due to the nature of the medication. Many HIV drugs are bitter tablets that are difficult to swallow or are syrups that need refrigeration. These characteristics make it difficult to keep and to administer to children who need it.
The new flavored tablet dissolves in water or juice, making it easy for children to consume. About 80,000-100,000 children die of AIDS-related illnesses every year, according to the WHO, making accessible treatment even more important.
What is dolutegravir?
Dolutegravir, also known as Tivicay, is a first-line medication for HIV. The drug is just one of many antiretroviral treatments (ARTs) available to HIV patients. Physicians typically prescribe a regimen of three different HIV drugs from varying classes.
According to Definitive Healthcare data, physicians prescribed Dolutegravir more than 298,700 times in 2019 - enough for 9.2 million days of treatment. Tivicay is the fifth most prescribed drug for HIV treatment. The new dissolvable formulation will likely bump Tivicay higher up the list in 2021 as physicians prescribe it to HIV+ children. However, it probably won't outseat Truvada, the most-prescribed HIV treatment. Physicians prescribed Truvada more than 646,000 times in 2019.
How many people are affected by HIV?
Physicians reported more than 1.6 million HIV diagnoses in 2019 according to Definitive Healthcare data. These diagnoses cover all reports of HIV across provider types.
The new Tivicay (Dolutegravir) formulation targets infants more than one month old. It is difficult to pinpoint just how many infants and children in the U.S. are diagnosed with HIV every year due to restrictions around medical records of minors.
We are able to identify a subset of this population through their parents. In this case, we can identify the number of pregnancy complications due to HIV. Because HIV is often passed from parent to child during birth or breastfeeding, it is likely that many of these cases will result in a child with HIV.
States with the highest volumes of HIV-related pregnancy complications
- Texas: 3,285
- New York: 2,636
- Florida: 1,494
- Georgia: 968
- Maryland: 653
Fig 1. Diagnosis data is from Definitive Healthcare’s Medical Claims database. Commercial claims data is from multiple medical claims clearinghouses in the United States. Data is updated monthly. HIV-related pregnancy complications found using ICD-10 codes beginning with “O9871”, which includes reports of complications in the first, second, third, or unspecified trimesters. Claims data covers calendar year 2019. Accessed December 11, 2020.
Populations with the highest risk of contracting HIV
After men, Black heterosexual women are at the highest risk of contracting HIV. According to Definitive Healthcare data, physicians reported 16,570 cases of HIV complicating pregnancy in 2019.
States with the highest volumes of HIV diagnoses
- New York: 356,670
- California: 165,846
- Florida: 154,926
- Texas: 119,365
- Pennsylvania: 73,850
Fig 2. Diagnosis data is from Definitive Healthcare’s Medical Claims database. Commercial claims data is from multiple medical claims clearinghouses in the United States. Data is updated monthly. HIV diagnoses found using ICD-10 code B20, “Human immunodeficiency virus [HIV] disease.” Claims data covers calendar year 2019. Accessed December 11, 2020.
As you can see above, HIV diagnoses are centered in New York. This is probably not a surprise considering New York City’s large and very diverse population. HIV is most common among gay and bisexual men — especially Black and Latino men. The New York City metropolitan area has one of the largest LGBTQ populations in the country. It also has one of the highest for LGBTQ population density.
New York, Florida, and Texas all ranked among the highest for both volume of HIV diagnoses and HIV-related pregnancy complications. This is not unexpected — all three of these states report large and racially diverse populations.
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