Uncontrolled ARVs could fuel drug-resistant HIV

The unregulated supply of anti-AIDS drugs in poor countries could accelerate the development of drug-resistant HIV strains, a new report has found. As the main HIV treatment provider in developing countries, the private sector had to be properly controlled to ensure that antiretrovirals (ARVs) did not become useless, according to a study by the London School of Hygiene and Tropical Medicine. Global drug access initiatives "largely ignored" the increasing number of poor people who sought care in the private sector, fearing stigma and discrimination elsewhere. Consequently, the provision of ARVs by private doctors, pharmacists, and informal providers - such as drug vendors - was often unregulated and at times illegal, the study published in the British Medical Journal noted. Although welcoming recent drug price cuts by major pharmaceutical companies, the study warned that this would increase illegal leakage into the private sector. "Evidence of uncontrolled use is already emerging in the formal sector and, more worryingly, the informal private sector," it said. In Zimbabwe, a quarter of 68 private physicians in 2000 were prescribing ARVs, and their prescribing practices were described as "therapeutic anarchy", with doctors and pharmacists using "any ARV that they could lay their hands on", the report found. A survey of 21 Ugandan private medical facilities reported that only four of 17 establishments prescribing ARVS had received CD4 and viral load results in the previous two months - for just 38 of the 340 patients they were monitoring. Existing guidelines for managing patients on antiretroviral therapy (ART) use viral load and CD4 count testing to measure the impact of ART on the patient's health. In addition, at times drug suppliers changed patients' treatments because of differences in costs and availability of stock. These conditions increase the chances of drug-resistant HIV. The study called for better treatment guidelines, which took into account "public health realities" in resource-poor settings. It noted "Most poor countries lack two proved essentials for working with dominant and uncontrolled private sectors: financial leverage, and effective enforcement of regulatory controls." It was in the interest of pharmaceutical companies to provide strategies for monitoring prescribing practices - even in resource-poor settings - as this would delay the emergence of resistant HIV, the study concluded. More details: http://bmj.com/