Secondly, there's the question of costs. The prospect of finding the money for three-drug combinations in the near future is making many clinics cringe. The annual cost of triple-drug therapy could be 7,000 to 10,000 per person. The Chelsea and Westminster Hospital, the largest HIV clinic in the country, is already imposing restrictions on its prescribing to save money. It's asking GPs to take on drugs that they can safely prescribe, as well as some AIDS-related drugs that haven't been definitively proven.
Cost is also an obstacle to the widespread use of viral load tests.
At the minority of hospitals which have an in-house academic department of virology, the cost per test is around 80 plus about half an hour of a skilled technician's time. Other clinics will have to 'buy in' the test, resulting in higher bills. Some doctors are already arguing that a central NHS laboratory should be established for HIV viral load tests, providing economies of scale. At the moment, only one London clinic has introduced viral load tests as part of its regular patient care. A few other clinics hope to start using the test in the coming months.