People not getting the treatment they need to stay alive

Newer Aids drugs unaffordable and unavailable

Tomorrow (1 December) is World AIDS Day. AIDS treatment in the developing world will not be sustainable unless international institutions get serious about the high cost of newer medicines, the international medical humanitarian organisation Médecins Sans Frontières (MSF) warned today. Five months after the World Health Organization (WHO) released updated AIDS treatment guidelines that recommend the use of newer and improved drugs in developing countries, the organisation has failed to outline a strategy to help countries access these drugs, which remain largely inaccessible in developing countries.

New WHO-recommended drug regimens for patients starting treatment can be up to six times more expensive than today's most commonly used combination. In addition, due to drug resistance or side effects, people on antiretroviral treatment eventually need to switch to newer drugs. In the case of resistance, people need to receive entirely new drug combinations, or face becoming sick again and dying. This "second-line" therapy can be up to 50 times more expensive.

"Our experience over the last year has told us two things. First, treatment costs are going to rise massively in the coming years unless something is done about high drug prices. Second, we cannot rely on pharmaceutical companies to solve this problem. We need drastic changes in strategy," said Dr. Tido von Schoen-Angerer, Director of MSF's Campaign for Access to Essential Medicines. "It's clear as day that at current prices, the cost of accessing newer drugs will bankrupt treatment programmes, but governments, industry, and multilateral agencies are doing far too little to address the issue."

Currently, MSF provides antiretroviral therapy to over 80,000 patients in 65 projects in more than 30 countries. Data from MSF's programme in South Africa, which is one of the organisation's longest running treatment programmes, shows that 17.4% of people who have been on treatment for five years have had to switch to second-line therapy. In Malawi, where MSF has 11,000 people on AIDS treatment, it is estimated that roughly 1,600 people will need to switch to newer drug combinations in three years, which will take up 70% of the entire treatment budget.

"AIDS treatment became a reality in the developing world because of the availability of affordable generic drugs," said Dr. von Schoen-Angerer. "Treatment programmes will fail unless a continual supply of generic versions of newer medicines is also guaranteed."

Generic competition since 2000 helped bring down prices of certain first-line AIDS drugs by 99%, from US$10,000 to roughly US$130 per patient per year. Yet prices for newer drugs will remain high primarily due to increased patent barriers in key generic-producing countries like India. On top of cost, newer medicines often are not marketed in developing countries.

"Many newer drugs are not even available where we work, because companies do not make a priority of registering them," said Dr. Moses Massaquoi of MSF in Malawi. "It's simply unacceptable that we have to wait many years to use medicines that are commonly used in wealthy countries, if we get them at all."

Tenofovir, one of the most commonly prescribed AIDS drugs in wealthy countries and one of the drugs recommended by WHO, was approved for use in the US in 2001, but Gilead, the manufacturer, has only registered it in roughly 15 of 97 developing countries that qualify for the company's reduced pricing. Abbott launched an improved version of one of its antiretrovirals - heat stable lopinavir/ritonavir - over a year ago in the US, but the drug is still not registered in a single developing country, even though the new formulation is much better adapted to tropical settings. For most developing countries outside of Africa, such as Thailand and Guatemala, the company has announced a price of US$2,200 per year, which is far more than the average annual income in those countries.

A high-level meeting of WHO, UNAIDS and the World Bank concluding today in Washington, DC has failed to address the fact that pharmaceutical patents continue to drive the price of treatment up.

"Donor money should not be squandered to pay for overpriced drugs. The priority is to make drug prices come down as much as possible," said Dr. von Schoen-Angerer. "International organizations, donors and industry must overhaul their strategies to ensure that universal access to AIDS treatment for life becomes a reality - this means confronting companies and their patents."

MSF began providing HIV/AIDS prevention and care services in the 1990s. In 2000, MSF introduced antiretroviral therapy in its projects in Thailand, South Africa, and Cameroon.