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© Francesco Zizola / Noor |
“We are seeing a major crisis looming for people living with HIV/AIDS in the developing world. As doctors, we are deeply concerned to avoid the situation of the late 1990s, when people faced a death sentence because they could not afford the life-saving medicines widely available in rich countries.” Dr. Tido von Schoen-Angerer, Executive Director, Campaign for Access to Essential Medicines.
The need to switch treatments
As people on antiretroviral treatment (ART) develop intolerable side effects or start to develop resistance to their first set of antiretroviral medicines (ARVs), they need to switch to a different drug combination. Compliance to treatment is important to prevent viral resistance, which will allow the HIV virus to replicate and mutate.
In one of MSF’s long-standing HIV/AIDS projects, in Khayelitsha, South Africa, 16 percent of patients need to be switched to ‘second-line’ therapy after five years of treatment. Indeed, in wealthy countries, many people living with AIDS have changed their treatment lines four, five or even six times. With two million people on ARVs across the developing world, the need for access to newer ARV options is growing rapidly.
The need for less-toxic regimens
Further, the World Health Organization has recommended that a newer, less-toxic drug, tenofovir, be used in first-line treatment. This is intended to help avoid the side effects some people suffer from one of the primary drugs used in today’s most widely-used combination, stavudine.
It is crucial that people receive the best possible and least-toxic treatment from the start: this ensures that people are able to stay on that combination for as long as possible before needing to switch. This is especially important when there are few drug options to switch to, as is the case in developing countries, and because the second and further treatment combinations have less chance of success.
However, at best, the improved first-line regimen containing the drug tenofovir as recommended by WHO costs from US$169 to US$243 for one patient's yearly treatment, from generic companies. And for lower middle income countries
(LMIC) affected by patent barriers, the originator fixed-dose combination containing tenofovir remains unchallenged by generic competitors and the price remains high at US$ 1033. That compares with a price of US$80 per patient per year for the older, more toxic regimen that was previously recommended.
The skyrocketing cost of newer drugs
The price of newer AIDS drugs for second and further lines of treatment is dramatically higher than the cost of the older ones. While costs have come down, the cost of the cheapest second-line regimens ranges from US$620 - US$ 993 per patient per year and is therefore 8-12 times the price of the older first-line regimen.
There is a real risk that patients will again be faced with a situation where treatment is priced out of reach.
Last updated July 2009
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