What risk of death would people take to be cured of HIV and why? A survey of people living with HIV

Benjamin R Murray¹, Allison Kratka¹, Karen A Scherr^{1

2}, Nir Eyal³, Jennifer Blumenthal-Barby⁴, Kenneth A Freedberg^{3

5

6}, Daniel R Kuritzkes^{6

7}, James K Hammitt^{3

8}, Regina Edifor⁹, Madelaine N Katz^{2

10}, Kathryn I Pollak^{1

11}, Brian J Zikmund-Fisher^{12

13}, Scott D Halpern¹⁴, Mary C Barks^{2

10}, Peter A Ubel^{1

2

10}

Affiliations

¹ Duke University School of Medicine, Durham, NC, USA.
² Duke University Fuqua School of Business, Durham, NC, USA.
³ Harvard TH Chan School of Public Health, Boston, MA, USA.
⁴ Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, TX, USA.
⁵ Medical Practice Evaluation Center, Divisions of General Internal Medicine and Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Harvard Medical School, Boston, MA, USA.
⁷ Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Toulouse School of Economics, University of Toulouse Capitole, Toulouse, France.
⁹ University of Massachusetts Medical School, Worcester, MA, USA.
¹⁰ Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
¹¹ Population Health Sciences, Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA.
¹² Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
¹³ Center for Bioethics and Social Sciences in Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.
¹⁴ Departments of Medicine and Medical Ethics in Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

PMID: 31191914
PMCID: PMC6543487
DOI: 10.1016/S2055-6640(20)30052-2

Editorial

What risk of death would people take to be cured of HIV and why? A survey of people living with HIV

Benjamin R Murray et al. J Virus Erad. 2019.

. 2019 Apr 1;5(2):109-115.

doi: 10.1016/S2055-6640(20)30052-2.

Authors

Affiliations

¹ Duke University School of Medicine, Durham, NC, USA.
² Duke University Fuqua School of Business, Durham, NC, USA.
³ Harvard TH Chan School of Public Health, Boston, MA, USA.
⁴ Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, TX, USA.
⁵ Medical Practice Evaluation Center, Divisions of General Internal Medicine and Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Harvard Medical School, Boston, MA, USA.
⁷ Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Toulouse School of Economics, University of Toulouse Capitole, Toulouse, France.
⁹ University of Massachusetts Medical School, Worcester, MA, USA.
¹⁰ Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
¹¹ Population Health Sciences, Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA.
¹² Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
¹³ Center for Bioethics and Social Sciences in Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.
¹⁴ Departments of Medicine and Medical Ethics in Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

PMID: 31191914
PMCID: PMC6543487
DOI: 10.1016/S2055-6640(20)30052-2

Abstract

People living with HIV (PLWHIV) can reasonably expect near-normal longevity, yet many express a willingness to assume significant risks to be cured. We surveyed 200 PLWHIV who were stable on antiretroviral therapy (ART) to quantify associations between the benefits they anticipate from a cure and their risk tolerance for curative treatments. Sixty-five per cent expected their health to improve if cured of HIV, 41% predicted the virus would stop responding to medications over the next 20 years and 54% predicted experiencing serious medication side effects in the next 20 years. Respondents' willingness to risk death for a cure varied widely (median 10%, 75th percentile 50%). In multivariate analyses, willingness to risk death was associated with expected long-term side effects of ART, greater financial resources and being employed (all P < 0.05) but was not associated with perceptions of how their health would improve if cured.

Keywords: HIV; medication; risk taking; treatment.

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Figures

**Figure 1.**
Stated risk tolerance on a continuous scale. The x-axis is not proportional to highlight responses of interest

**Figure 2.**
Participant expectations for their antiretroviral medications over the next 20 years. Boxes represent the interquartile range. The centre line is the median and whiskers show the range of responses

**Figure 3.**
Current health and predicted health in 5 years, with and without a cure. Boxes represent the interquartile range. The centre line is the median and the whiskers show the range of responses. The P-values indicate whether there is a significant change in the distribution of scores between current and predicted health in 5 years

**Figure 4.**
Expected change in likelihood of negative health event occurring in the next 20 years if cured of HIV (n = 193)

See this image and copyright information in PMC

References

1. World Health Organization 15 Facts on HIV treatment scale-up and new WHO ARV guidelines. 2013. Available at: www.who.int/hiv/pub/guidelines/arv2013/15facts/en/ ( accessed March 2019).
1. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet 2013; 382: 1525– 1533. - PMC - PubMed
1. Nakagawa F, Lodwick RK, Smith CJ et al. . Projected life expectancy of people with HIV according to timing of diagnosis. AIDS 2012; 26: 335– 343. - PubMed
1. Van Sighem AI, Gras LA, Reiss P et al. . Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals. AIDS 2010; 24: 1527– 1535. - PubMed
1. Rodger AJ, Lodwick R, Schechter M et al. . Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population. AIDS 2013; 27: 973– 979. - PubMed

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What risk of death would people take to be cured of HIV and why? A survey of people living with HIV

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What risk of death would people take to be cured of HIV and why? A survey of people living with HIV

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