HIV Specialist - June 2021 - 35

world, we emphasize the importance of HIV
prevention. Pre-exposure prophylaxis (PrEP)
with antiretroviral drugs is an effective
strategy for preventing HIV infection and
many countries have approved oral medications
for PrEP However, in Japan PrEP is not
readily available because there are no drugs
approved for this indication and thus remains
an important issue for our country to address.
Social Security System for
Medical Expenses
In Japan, there is both government and
private health insurance options. In most
cases, 70 percent of medical costs are covered
by these insurance systems which means the
patients is responsible to pay 30 percent of
their medical costs. In the case of PWH, insurance
is more complicated. Before starting
HIV treatment, the insured person needs to
apply for another supportive system to receive
subsidies for the self-paid portion of the
expenses for HIV care. By using this system,
the self-paid portion drops to 10 percent.
However, there is a ceiling for the self-paid
amount according to the income earned by
the patient in the previous year.
The application process is complicated.
Therefore, in most hospitals in Japan where
HIV specialists provide comprehensive HIV
care, several coordinators generally help
PWH apply for these subsidies. The greatest
benefit of this system is that a primary
are the patient's primary doctor can select
any approved ART without limitations. The
treating physician and prescribe single-tablet
therapies such as Biktarvy® (bictegravir/tenofovir
alafenamide/emtricitabine), Dovato®
(dolutegravir/lamivudine) or other acceptable
ART regimens at the same cost.
Japan adopted the universal health
insurance system which covers all citizens.
Therefore, in most cases, people can start
REFERENCE
1. Global HIV&AIDS statistics, UNAIDS. Available at https://
www.unaids.org/en/resources/fact-sheet [accessed 11 May
2021]
2. Annual report, AIDS Prevention Information Network.
Available at https://api-net.jfap.or.jp/status/japan/nenpo.
html [accessed 11 May 2021]
3. U.S. Statistics, HIV gov. Available at https://www.hiv.gov/
hiv-basics/overview/data-and-trends/statistics [accessed
11 May 2021]
4. Annual report, drug resistance HIV information center.
Available at https://www.hiv-resistance.jp/research03.htm
[accessed 11 May 2021]
5. Fogel et al. AIDS. 2020; 34: 91-101 HIV drug resistance in a
cohort of HIV-infected MSM in the United States.
6. Iwamoto et al. PLoS One. 2017; 12:e0174360. The HIV care
cascade: Japanese perspectives.
7. Nishijima et al. AIDS. 2020; 34:913-921. Mortality and
causes of death in people living with HIV in the era of
combination antiretroviral therapy compared with the
general population in Japan.
8. Oka et al. Glob Health Med. 2020;2:9-17. Pathogenesis,
Clinical course, and recent issues in HIV-1-infected
Japanese hemophiliacs: a three-decade follow-up.
9. Oka et al. Glob Health Med. 2019;1:49-54. Non-AIDSdefining
malignancies in Japanese hemophiliacs with
HIV-1 infection.
Japan's light blue health insurance card, red medical examination card, and personal medical card.
ART therapy inexpensively. However as noted
above the process is time consuming, and
it generally takes one to two months to complete
the process. Clinicians in Japan cannot
initiate ART soon after the diagnosis of
HIV except for patients with AIDS-defining
illness. This is a serious problem in Japan
because the evidence for rapid initiation
of ART is growing worldwide. The system
needs to be changed little by little based on
scientific evidence.
Special Population
In the 1980's, about 30 percent (n=1,432) of
hemophiliacs in Japan were infected with
HIV through contaminated blood products.
This also happened in other countries
including the United States and the United
Kingdom before it was determined that HIV
could be transmitted by the transfusion of
blood or blood products. 8 This is sometimes
referred to as the " blood scandal " . Among
those in Japan who were infected with HIV,
50.4 percent of were still alive as of the end
of 2017. One of our missions is to provide
continuous care for these individuals. They
have some unique clinical characteristics
such as co-infection with hepatitis C virus.
Remarkably, the prevalence and the incidence
of non-AIDS defining malignancies
were 5.8 percent and 2.99 per 100 person
between 2016-2019 in this population. 9
This surprisingly high rate could mean that
Japanese hemophiliacs might be at increased
risk for non-AIDS defining malignancies.
Consequently, some experts believe hemophiliacs
with HIV should be screened more
frequently for non-AIDS defining malignancies
than the general population.
In summary, Japan is a country with low
HIV prevalence and those PWH in Japan
achieve very good treatment outcomes with
ART. However, there are still many issues to
be addressed to improve HIV prevention, early
diagnosis and treatment - key issues which
will contribute to the global goal of ending the
HIV epidemic. HIV
NAOKATSU ANDO, MD, AAHIVS,
is an infectious diseases physician at the
AIDS Clinical Center, National Center for
Global Health and Medicine, Tokyo,
Japan. His primary research interests
focus on HIV, Sexually transmitted infections and
public health.
SHUTTERSTOCK/ UMARUCHAN4678
WWW.AAHIVM.ORG HIVSPECIALIST JUNE 2021 35
http://www.unaids.org/en/resources/fact-sheet https://www.hiv-resistance.jp/research03.htm http://www.unaids.org/en/resources/fact-sheet https://api-net.jfap.or.jp/status/japan/nenpo.html http://api-net.jfap.or.jp/status/japan/nenpo.html https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics http://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics http://WWW.AAHIVM.ORG

HIV Specialist - June 2021

Table of Contents for the Digital Edition of HIV Specialist - June 2021

HIV Specialist - June 2021 - Cover1
HIV Specialist - June 2021 - Cover2
HIV Specialist - June 2021 - 1
HIV Specialist - June 2021 - 2
HIV Specialist - June 2021 - 3
HIV Specialist - June 2021 - 4
HIV Specialist - June 2021 - 5
HIV Specialist - June 2021 - 6
HIV Specialist - June 2021 - 7
HIV Specialist - June 2021 - 8
HIV Specialist - June 2021 - 9
HIV Specialist - June 2021 - 10
HIV Specialist - June 2021 - 11
HIV Specialist - June 2021 - 12
HIV Specialist - June 2021 - 13
HIV Specialist - June 2021 - 14
HIV Specialist - June 2021 - 15
HIV Specialist - June 2021 - 16
HIV Specialist - June 2021 - 17
HIV Specialist - June 2021 - 18
HIV Specialist - June 2021 - 19
HIV Specialist - June 2021 - 20
HIV Specialist - June 2021 - 21
HIV Specialist - June 2021 - 22
HIV Specialist - June 2021 - 23
HIV Specialist - June 2021 - 24
HIV Specialist - June 2021 - 25
HIV Specialist - June 2021 - 26
HIV Specialist - June 2021 - 27
HIV Specialist - June 2021 - 28
HIV Specialist - June 2021 - 29
HIV Specialist - June 2021 - 30
HIV Specialist - June 2021 - 31
HIV Specialist - June 2021 - 32
HIV Specialist - June 2021 - 33
HIV Specialist - June 2021 - 34
HIV Specialist - June 2021 - 35
HIV Specialist - June 2021 - 36
HIV Specialist - June 2021 - 37
HIV Specialist - June 2021 - 38
HIV Specialist - June 2021 - 39
HIV Specialist - June 2021 - 40
HIV Specialist - June 2021 - 41
HIV Specialist - June 2021 - 42
HIV Specialist - June 2021 - 43
HIV Specialist - June 2021 - 44
HIV Specialist - June 2021 - 45
HIV Specialist - June 2021 - 46
HIV Specialist - June 2021 - 47
HIV Specialist - June 2021 - 48
HIV Specialist - June 2021 - 49
HIV Specialist - June 2021 - 50
HIV Specialist - June 2021 - 51
HIV Specialist - June 2021 - 52
HIV Specialist - June 2021 - Cover3
HIV Specialist - June 2021 - Cover4
https://www.nxtbook.com/ygsreprints/AAHIVM/hiv-specialist-june-2021
https://www.nxtbook.com/ygsreprints/AAHIVM/hiv-specialist-march-2021
https://www.nxtbook.com/ygsreprints/AAHIVM/G121337_AAHIV_122020
https://www.nxtbook.com/ygsreprints/AAHIVM/G119632_AAHIV_092020
https://www.nxtbook.com/ygsreprints/AAHIVM/G118334_AAHIV_062020
https://www.nxtbook.com/ygsreprints/AAHIVM/G116663_AAHIVM_032020
https://www.nxtbookmedia.com