Evaluation of epidemiological and economic consequences due to the delay in treatment of hiv-positive patients caused by the covid-19 pandemic


  • Andrea Marcellusi Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome “Tor Vergata”, Rome - Italy and Institute for Leadership and Management in Health – Kingston University London, London - UK https://orcid.org/0000-0002-3974-3798
  • Chiara Bini Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome “Tor Vergata”, Rome - Italy
  • Massimo Andreoni University of Tor Vergata, Rome - Italy
  • Andrea Antinori National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome - Italy
  • Francesco Saverio Mennini Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome “Tor Vergata”, Rome - Italy and Institute for Leadership and Management in Health – Kingston University London, London - UK




Acquired Immunodeficiency Syndrome Virus, Coronavirus Disease, COVID-19 Pandemic, Human immunodeficiency virus


Objective: To assess, from an epidemiological and economic point of view, the consequences of the reduction in the supply of antiretroviral drugs due to the COVID-19 pandemic.

Method: The analysis was conducted by adapting a Markov model previously published in literature. The simulations were conducted considering the possibility of continuous treatment for patients already diagnosed (no therapeutic interruptions are expected) and an immediate start of patients with new diagnosis during 2021. This analysis was compared with a scenario involving a therapeutic interruption or diagnostic delay caused by COVID-19.

Results: The analysis showed that the scenario characterized by a treatment delay, compared to the scenario of early resumption of therapy, could generate an increase in the number of patients with CD4 < 200 equal to 1,719 subjects (+16%) and a reduction in the number of patients with CD4 500 equal to 6,751 (−9%). A timely resumption of treatment for HIV+ patients could prevent 296, 454 and 687 deaths in the third, fifth and tenth years of analysis respectively with a potential cost reduction equal to 78,9 million at a 10 year time horizon.

Conclusions: These findings show that it is essential, especially in a pandemic situation such as the present one, to introduce technological, digital and organizational solutions, aimed at promoting timely diagnosis and at accelerating the therapeutic switch for patients who are no longer targeted.


Download data is not yet available.


UNAIDS. Global HIV & AIDS statistics — 2020 fact sheet. Online https://www.unaids.org/en/resources/fact-sheet. (Access September 2021)

Mammone A, Pezzotti P, Regine V, et al. How many people are living with undiagnosed HIV infection? An estimate for Italy, based on surveillance data. AIDS. 2016;30(7):1131-1136. https://doi.org/10.1097/QAD.0000000000001034 PMID:26807973 DOI: https://doi.org/10.1097/QAD.0000000000001034

Istituto Superiore di Sanità, Aggiornamento delle nuove diagnosi di infezione da HIV e dei casi di AIDS in Italia al 31 dicembre 2018, in Notiziario dell’ISS. 2019. Online https://www.epicentro.iss.it/aids/epidemiologia-italia (Access September 2021)

Istituto Superiore di Sanità. Infezione da Hiv e Aids - Le terapie. Online https://www.epicentro.iss.it/aids/terapie. (Access September 2021)

UNAIDS. End Inequalities. End Aids. Global Aids Strategy 2021-2026. 2021; Onlne: https://www.unaids.org/sites/default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf. (Access September 2021)

ECDC. Continuum of HIV care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Online https://www.ecdc.europa.eu/sites/portal/files/documents/Continuum-of-HIV-care-2017.pdf. (Access September 2021)

Quiros-Roldan E, Magro P, Carriero C, et al. Consequences of the COVID-19 pandemic on the continuum of care in a cohort of people living with HIV followed in a single center of Northern Italy. AIDS Res Ther. 2020;17(1):59. https://doi.org/10.1186/s12981-020-00314-yPMID:33012282 DOI: https://doi.org/10.1186/s12981-020-00314-y

Marcellusi A, Viti R, Russo S, Andreoni M, Antinori A, Mennini FS. Early Treatment in HIV Patients: A Cost-Utility Analysis from the Italian Perspective. Clin Drug Investig. 2016;36(5):377-387. https://doi.org/10.1007/s40261-016-0382-2 PMID:26940802 DOI: https://doi.org/10.1007/s40261-016-0382-2

Mangal TD, Progression UWGC, Mortality Amongst HIVSCCE; UNAIDS Working Group on CD4 Progression and Mortality Amongst HIV Seroconverters including the CASCADE Collaboration in EuroCoord. Joint estimation of CD4+ cell progression and survival in untreated individuals with HIV-1 infection. AIDS. 2017;31(8):1073-1082. https://doi.org/10.1097/QAD.0000000000001437 PMID:28301424 DOI: https://doi.org/10.1097/QAD.0000000000001437

Associazione Italiana Economia Sanitaria (AIES). Proposta di Linee-Guida per la valutazione economica degli interventi sanitari. Poilitiche Sanitarie. 2009;10(2):91-99.

d’Arminio Monforte A, Diaz-Cuervo H, De Luca A, et al; ICONA Foundation Study Group. Evolution of major non-HIV-related comorbidities in HIV-infected patients in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) Foundation Study cohort in the period 2004-2014. HIV Med. 2019;20(2):99-109. https://doi.org/10.1111/hiv.12683 PMID:30461158 DOI: https://doi.org/10.1111/hiv.12683

Frank TD, Carter A, Jahagirdar D, et al; GBD 2017 HIV collaborators. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Lancet HIV. 2019;6(12):e831-e859. https://doi.org/10.1016/S2352-3018(19)30196-1 PMID:31439534 DOI: https://doi.org/10.1016/S2352-3018(19)30196-1

Mocroft A, Furrer HJ, Miro JM, et al; Opportunistic Infections Working Group on behalf of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCOORD. The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era. Clin Infect Dis. 2013;57(7):1038-1047. https://doi.org/10.1093/cid/cit423 PMID:23921881 DOI: https://doi.org/10.1093/cid/cit423

Simpson KN, Luo MP, Chumney E, Sun E, Brun S, Ashraf T. Cost-effectiveness of lopinavir/ritonavir versus nelfinavir as the first-line highly active antiretroviral therapy regimen for HIV infection. HIV Clin Trials. 2004;5(5):294-304. https://doi.org/10.1310/WT81-MEM4-5C4L-CHPK PMID:15562370 DOI: https://doi.org/10.1310/WT81-MEM4-5C4L-CHPK

Kauf TL, Roskell N, Shearer A, et al. A predictive model of health state utilities for HIV patients in the modern era of highly active antiretroviral therapy. Value Health. 2008;11(7):1144-1153. https://doi.org/10.1111/j.1524-4733.2008.00326.x PMID:18494750 DOI: https://doi.org/10.1111/j.1524-4733.2008.00326.x

Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ. 2002;21(2):271-292. https://doi.org/10.1016/S0167-6296(01)00130-8PMID:11939242 DOI: https://doi.org/10.1016/S0167-6296(01)00130-8

Trapero-Bertran M, Oliva-Moreno J. Economic impact of HIV/AIDS: a systematic review in five European countries. Health Econ Rev. 2014;4(1):15. https://doi.org/10.1186/s13561-014-0015-5 PMID:26208918 DOI: https://doi.org/10.1186/s13561-014-0015-5

OSMED. L'uso dei farmaci in Italia. Rapporto nazionale. Anno 2019. Online https://www.aifa.gov.it/documents/20142/1205984/rapporto-osmed-2019.pdf/f41e53a4-710a-7f75-4257-404647d0fe1e. (Access September 2021)

Hogan AB, Jewell BL, Sherrard-Smith E, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020;8(9):e1132-e1141. https://doi.org/10.1016/S2214-109X(20)30288-6 PMID:32673577 DOI: https://doi.org/10.1016/S2214-109X(20)30288-6

Jewell BL, Mudimu E, Stover J, et al; HIV Modelling Consortium. Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models. Lancet HIV. 2020;7(9):e629-e640. https://doi.org/10.1016/S2352-3018(20)30211-3 PMID:32771089 DOI: https://doi.org/10.1016/S2352-3018(20)30211-3

Rizzardini G, Restelli U, Bonfanti P, et al. The cost of HIV disease in Northern Italy: the payer’s perspective. J Acquir Immune Defic Syndr. 2011;57(3):211-217. https://doi.org/10.1097/QAI.0b013e31821fdee2 PMID:21546850 DOI: https://doi.org/10.1097/QAI.0b013e31821fdee2

Rizzardini G, Bonfanti P, Carenzi L, et al. Cost-effectiveness analysis of HIV treatment in the clinical practice of a public hospital in northern Italy. Ther Clin Risk Manag. 2012;8:377-384. PMID:23028230 DOI: https://doi.org/10.2147/TCRM.S33674

Foglia E, Bonfanti P, Rizzardini G, et al. Cost-utility analysis of lopinavir/ritonavir versus atazanavir + ritonavir administered as first-line therapy for the treatment of HIV infection in Italy: from randomised trial to real world. PLoS One. 2013;8(2):e57777. https://doi.org/10.1371/journal.pone.0057777 PMID:23460905 DOI: https://doi.org/10.1371/journal.pone.0057777

Additional Files



How to Cite

Marcellusi, A., Bini, C., Andreoni, M., Antinori, A., & Mennini, F. S. (2021). Evaluation of epidemiological and economic consequences due to the delay in treatment of hiv-positive patients caused by the covid-19 pandemic. Global and Regional Health Technology Assessment, 8(1), 147–154. https://doi.org/10.33393/grhta.2021.2279



Original Research Articles


Received 2021-05-11
Accepted 2021-08-30
Published 2021-10-25


Most read articles by the same author(s)

1 2 > >>