The analysis, published in JAMA Network Open, estimates that nearly 122,000 older adults receiving HIV treatment could be enrolled in Medicare by the end of 2026. By the end of 2035, that number may reach approximately 193,600. The increase reflects improvements in survival associated with modern antiretroviral therapy, as well as the aging of people who acquired HIV during earlier decades of the epidemic.

Researchers from the Medical Practice Evaluation Center within the Mass General Brigham Department of Medicine developed a new simulation model called CHARMED to estimate the future size and cost of this population. CHARMED was populated using projections from the previously validated CEPAC model, Medicare claims data, and publicly available demographic and health-care information. The model simulated Medicare beneficiaries living with HIV, aged 65 years and older, who were receiving antiretroviral therapy, and estimated their treatment and medical expenditures over time.

The projections indicate that annual Medicare spending for this population could increase from $10.9 billion at the end of 2026 to $27.3 billion by the end of 2035. Across the full 10-year period, cumulative spending was estimated at $187.2 billion. Antiretroviral therapy accounted for approximately 63 percent of the projected total, highlighting the central role of drug prices in determining the financial impact of HIV care for Medicare.

The high proportion attributed to antiretroviral therapy reflects the distinctive economics of HIV treatment. Unlike many therapies prescribed for limited periods, antiretroviral medicines must be taken continuously to suppress viral replication. Effective suppression prevents progression to AIDS and sharply reduces the likelihood of transmitting HIV, but it also creates a lifelong pharmaceutical expense. Interruptions in treatment can allow the virus to rebound and may increase the risk of drug resistance, making sustained access essential for both individual and public health.

The investigators also modeled scenarios in which antiretroviral prices declined. A 60 percent reduction in treatment costs could save Medicare an estimated $70.3 billion over the next decade. Under current prescribing patterns, policies already expected to influence HIV drug prices could produce more modest but still substantial savings. The Inflation Reduction Act allows Medicare to negotiate the price of Biktarvy, the most commonly prescribed antiretroviral regimen in the United States, with negotiated prices scheduled to take effect in 2028. In addition, generic dolutegravir is expected to become available in 2031, potentially enabling a highly effective, well-tolerated, and fully generic treatment regimen.

If those developments occur as anticipated, the model estimates that Medicare could save approximately $19 billion between 2026 and 2035. The analysis suggests that lowering drug prices could reduce public spending without requiring patients to pay more or face tighter restrictions on access. Such approaches contrast with proposals that would shift costs to beneficiaries through higher premiums, narrower drug coverage, or stricter eligibility for medication-assistance programs.

The study’s implications extend beyond the price of antiretroviral drugs. Older adults living with HIV have elevated risks of conditions such as cardiovascular disease, kidney disease, metabolic disorders, cancer, and neurocognitive impairment. Long-term HIV infection and the effects of chronic inflammation may contribute to these risks, while aging itself increases the likelihood of multiple simultaneous health problems. As a result, many Medicare beneficiaries with HIV may require coordinated management of several chronic conditions and may take multiple medications, increasing the possibility of drug interactions and treatment complications.

Clinicians and health systems will therefore need to prepare for a larger population requiring comprehensive, person-centered care. The researchers emphasize that future Medicare planning should account for both the rising number of older beneficiaries with HIV and the complex medical needs associated with aging while receiving lifelong treatment. Because the findings are based on simulation rather than observed future events, the exact figures will depend on changes in HIV incidence, survival, prescribing practices, drug prices, insurance policy, and access to care. Nevertheless, the projections identify antiretroviral pricing as a major and potentially modifiable driver of future Medicare spending.

Subject of Research: People

Article Title: Ten-Year Cost Projections for Medicare Beneficiaries 65 Years or Older with HIV

Web References: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2851282; https://mpec.massgeneral.org/

References: Hyle EP, et al. “Ten-Year Cost Projections for Medicare Beneficiaries 65 Years or Older with HIV.” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.21966

Keywords: HIV, human immunodeficiency virus, antiretroviral therapy, Medicare, older adults, aging population, health-care costs, medical economics, HIV policy, viral suppression, generic medicines, drug pricing

The trial was expansive and globally diverse, enrolling over 550 participants from 15 countries and including people with a median age of 60 years—significantly older than those typically included in HIV medication trials. This inclusion of an older demographic is particularly important given the unique challenges faced by aging people living with HIV, including polypharmacy and age-associated comorbidities, which often complicate treatment adherence and efficacy. Moreover, most participants in the study had extensive antiretroviral treatment histories, often involving between two and eleven daily pills, with nearly 40% adhering to multiple dosing schedules throughout the day.

At the core of this research lies a comparison between the newly formulated BIC/LEN single-tablet regimen and participants’ ongoing, more complicated treatment plans. Bictegravir, an integrase strand transfer inhibitor, works by preventing HIV from integrating its DNA into the host cell genome, a critical step in viral replication. Lenacapavir, a newer capsid inhibitor, targets the viral capsid—a protective shell surrounding the viral RNA—disrupting the virus’s ability to replicate and assemble. The combination of these two potent mechanisms of action in a once-daily pill offers a sophisticated therapeutic synergy designed to maintain robust viral suppression.

Remarkably, nearly 96% of those who transitioned to the BIC/LEN combination maintained viral loads under the critical threshold of 50 copies per milliliter, a benchmark indicative of effective viral suppression. This rate was nearly indistinguishable from the 94 to 96% viral suppression observed among participants who continued on their standard complex regimens, underlining that efficacy was uncompromised by the treatment simplification. Importantly, no emergent drug resistance was detected in the cohort treated with the new regimen, a key indicator of long-term treatment durability and effectiveness.

Safety and tolerability were crucial evaluation criteria given the older and clinically complex profile of the participants. The trial uncovered no novel or significant safety concerns associated with the BIC/LEN tablet. Interestingly, patients on the new regimen reported fewer lipid-related adverse events such as elevated cholesterol levels, suggesting an ancillary cardiovascular benefit. This finding is of particular clinical relevance as cardiovascular disease remains a leading cause of morbidity and mortality in aging HIV populations.

The trial’s evidence also highlights the psychosocial benefits of treatment simplification. Participants consistently reported that the single-pill regimen was easier and more convenient to integrate into their daily lives compared to their previous complex schedules. Simplifying medication regimens is directly linked to improved adherence, which is a pivotal factor in preventing viral rebound and resistance development. This streamlined approach could also reduce the cognitive and logistic burden on older adults living with HIV, many of whom manage multiple comorbidities requiring concurrent medications.

While the efficacy of multi-pill antiretroviral therapy has long been established, this study pioneers a shift towards regimen simplification without sacrificing virological control. This paradigm shift aligns with the broader goals of contemporary HIV care, emphasizing patient-centered treatment, minimized pharmacological toxicity, and reduction of pill burden. Given the global aging of the HIV population and the complexity inherent in their care, such advances are timely and highly impactful.

The study also offers insights for clinicians managing patients with histories of antiretroviral resistance or those with polypharmacy issues due to age-associated conditions like cardiovascular or kidney disease. By reducing pill burden, the BIC/LEN regimen could alleviate drug-drug interactions and improve overall regimen tolerability, critical to maintaining durable viral suppression and enhancing patient well-being over the long term.

The trial’s open-label, randomized controlled design lends robustness to its findings, ensuring rigorous comparison between the new BIC/LEN regimen and established therapies. Its multinational scope enhances the generalizability of the results across diverse populations and HIV subtypes. These factors together strengthen the credibility of BIC/LEN as a candidate for widespread adoption pending regulatory approvals.

Looking ahead, additional clinical trials are underway to cement the long-term safety profile and sustained effectiveness of bictegravir–lenacapavir combination therapy. These studies will be instrumental in validating the initial promising outcomes and assessing the treatment’s performance over extended periods, ensuring that any late-emerging adverse effects or resistance patterns are thoroughly characterized.

This milestone study is scheduled for presentation at the Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, Colorado, on February 25, 2026. CROI is one of the foremost global forums for cutting-edge HIV research dissemination, making it an ideal platform for unveiling this significant advance in HIV therapeutics.

In conclusion, the introduction of the bictegravir-lenacapavir single-tablet regimen represents a beacon of hope for the millions living with HIV who contend with complex, burdensome treatment schedules. By enabling high rates of viral suppression with a simplified dosing regimen, this innovation promises not only to improve clinical outcomes but also to enhance the lived experience of aging with HIV. As the scientific community continues to refine and validate this approach, the prospect of transforming HIV care with patient-friendly, effective regimens is rapidly becoming a tangible reality.

Subject of Research: People

Article Title: Switch to single-tablet bictegravir–lenacapavir from a complex HIV regimen (ARTISTRY-1): a randomised, open-label, phase 3 clinical trial

News Publication Date: 25-Feb-2026

References:
10.1016/S0140-6736(26)00307-7 (The Lancet)

Keywords:
Health and medicine, Human immunodeficiency virus