In light of this evidence, it is important to emphasize earlier diagnosis of HIV infection to prevent the complications to hospitalizations and higher associated costs. The cost of HAART accounted for 60% of the total direct costs. However, it should be recognized that HAART can offer financial returns to society, as many HIV-infected people of working age experienced improvements in their general health after HAART and became economically productive [4,6,18]. Our previous study conducted in the early HAART era demonstrated

that, at the population level, HAART produced a saving in direct in-patient costs, which appeared to be limited in time, because of the increase in the cost of antiretroviral drugs since the year 2000 this website [19]. Thus, it seems important to identify strategies to reduce the costs of HAART. The main contribution of this paper is to place the HIV epidemic in a general context, but the analysis has some limitations. First, it is not a cost-effectiveness analysis and indirect and intangible costs were not estimated. However, to the best of our knowledge, our analysis is the first to describe the occurrence of comorbidities in HIV-infected patients relative to the general population from a public health perspective. Moreover, the direct costs

were estimated using actual data on both out-patient Nintedanib and in-patient costs. Secondly, the analysis was limited to 5 years; longer term studies are therefore needed to better identify trends in view of the continuing evolution of HIV disease. Thirdly, it should be acknowledged that the association of some illnesses with HIV

infection can occur Ribose-5-phosphate isomerase as a result of the increased medical attention received by HIV-infected persons compared with the general population. This may lead to an overestimate of the incidence of comorbidities in the HIV-infected population. Lastly, costs were determined in this paper from the perspective of the public health care system. Thus, expenditures by the health care system, rather than actual costs, were estimated. Distortions in the fees paid by the health system may lead to an underestimate of the true opportunity cost of providing services. In conclusion, this population-based study shows that, notwithstanding the well-known benefits of HAART, HIV infection continues to impose high costs on the health system. Increases in the costs of antiretroviral medicines and the management of comorbidities, and the hospital costs associated with newly diagnosed patients, are important issues that require appropriate responses. Primary and secondary prevention of chronic comorbidities should be focused on the most vulnerable patients. Earlier diagnosis of HIV infection could help to prevent possible complications (e.g. treatment of chronic hepatitis coinfections, screening for cancers, or early diagnosis of psychiatric disorders).