Vienna 2010: Drug prices and new approaches to HIV treatment

Over the last decade, the scale-up of antiretroviral treatment (ART) to millions of people living with HIV/AIDS in developing countries has been possible thanks to a massive mobilization of resources and political will. The simplification of ART and the competition among drug manufacturers pushed prices for AIDS medicines down. More than four million people are alive today who would not be without treatment, and epidemiological trends show crucial progress in the battle against the epidemic.

The World Health Organization (WHO) has recently made important changes to treatment guidelines, and now recommends that people be provide treatment earlier, before the disease is allowed to progress. This would bring clinical practices in developing countries closer to standards adhered to in the developed world.

In new data from its treatment projects in Lesotho and Mozambique, Medecins Sans Frontieres (MSF) provides evidence that implementing early treatment initiation and improved first line regimen dramatically reduces mortality rates and makes treatment adherence easier for patients. But hope of these innovations reaching patients is in jeopardy due to high drug prices and a backtracking on treatment funding commitments from international donors.

At the XVIII International AIDS Conference in Vienna, MSF presented field research from its projects in Lesotho and Mozambique. In a two year study of 1,128 patients from rural Lesotho, where the government has adopted the new WHO guidelines, patients starting treatment earlier (at CD4 counts of less than 350) were 70 percent less likely to die, 40 percent less likely to remain in care, and more than 60 percent less likely to be hospitalized compared with those started when their viral load was already advanced (CD4 count less than 200).

“Treating people before they get very sick is better for the individual, better for the community and actually lessens the burden on the health system,” said Dr Helen Bygrave, HIV physician for MSF in Lesotho.

MSF also presented findings from its project in Mozambique where antiretroviral therapy was distributed through community groups. This simplified approach shows that patients in remote and poor areas can remain healthy and adhere to their treatment with limited reliance on health structures, showing similar outcomes as in clinic-based programmes.

In another study from Lesotho, MSF showed that the new WHO recommended first line combination with tenofovir leads to better health outcomes. A thirty percent price reduction for the recommended first line drug tenofovir would make the drug as cost-efficient as the older more toxic treatment with Stavudine. This is done by accounting for for the cost of treating side-effects, hospitalization and other expenses incurred through the continued use of the less effective treatments.

However, treatment scale is threatened by insufficient financial resources, increasing drug costs and patent protection, which is limiting generic competition for newer drugs. Drug companies have not been challenged at all on prices at this conference. Drugs costs need to be reduced more aggressively, making treatment easier for patients and ensuring more resources to increase access to treatment as early as possible.

AIDS 2010 brings us to critical crossroads that will determine the size and pace of the AIDS response for the coming years. We have to see how donors make political choices to fulfill their commitment to universal access to ART.

Ishdeep Kohli-CNS

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