Issues Related to Treatment and Care
In Taiwan, the AIDS Control Law was launched in 1990 and has been modified five times since then. Under the law, the government has to provide free treatment to all Taiwanese PLWHAs. Currently, there are 27 designated AIDS hospitals in Taiwan. As shown in Figure 5, the distribution of the hospitals was not even and some prefectures and cities do not have an AIDS hospital. The designated AIDS hospital system should be expanded to meet the medical need of the patients.
Highly Active Anti-Retroviral Therapy
Since April 1997, the Taiwanese government has started to provide protease inhibitors in conjunction with NRTI and NNRTI drugs. The cost of the highly active anti-retroviral therapy (HAART) is about 1,000 US$ per person per month. According to the Bureau of the National Health Insurance (BNHI), by the end of 2002, 2,660 of 3,425 (77.7%) PLWHAs have started to receive HAART. The implementation of the free HAART program in Taiwan has caused the dramatic decreases of both morbidity and mortality of HIV-1 infection in Taiwan. A five-year prospective study on a cohort of 309 PLWHAs (83% with AIDS) admitted to a teaching hospital in Taipei City showed that the mortality rate declined significantly from 110.5-148.4 per 100 patient-years in 1995 to 5.5-7.4 per patient-years in 1999. (Hung et al., 2000) The five leading HIV-1-associated OIs in the cohort were oroesophageal candidiasis, Pneumocystis carinii pneumonia, tuberculosis, mucocutaneous herpes simplex infection and cytomegalovirus diseases. (Hung et al., 2000) The clinical spectrum of AIDS patients in Taiwan was very similar to that in the Western countries, but the incidence of opportunistic infections (OIs) differed, e.g. the incidence (24.6%) of tuberculosis in patients with advanced illness was relatively high and the rate of an endemic fungal infection (Penicillium marneffei infection) was increasing. (Hsieh et al., 1996; Hsueh et al., 2000)
HIV-1 Drug Resistance
Although the BNMI provided free viral load and CD4 cell counts tests, the cost for genotyping of HIV-1 drug resistance was not covered. Recently, we investigated the prevalence of HIV-1 genotypic mutations in retrospective samples collected during 1997-2000 period. The results showed that among 136 treatment naïve PLWHAs, none of 31 heterosexual males, 32 bisexual males, 7 females and 4 IDUs had any primary mutation, while 2 of 62 (3.2%) homosexual males had M184V mutation for RT inhibitors. (Elbeik et al., 2002).