Anti-AIDS medication still too expensive - MSF report

As the prices of first-line anti-AIDS medication continue to fall, newer antiretrovirals (ARVs) can cost up to 12 times more in sub-Saharan Africa, according to a report by Medecines Sans Frontieres (MSF). Paediatric formulations were also more expensive than adult ARV drugs: treating a child for one year could be as much as US $816, while the same triple-drug regimen for adults was only $182. If these prohibitive costs were not cut soon, the South African government would have to dramatically scale up its budget for antiretroviral (ARV) drugs in the next few years, warned Marta Darder, the MSF spokeswoman in South Africa, which could lead to fewer people receiving the life-prolonging medication. People living with HIV/AIDS begin treatment on first-line drugs, and only need second-line ARVs when they become resistant to first-line medication. Since the country's treatment programme is still in its early stages, few HIV-positive patients have thus far developed resistance. One of MSF's privately funded ARV rollout programmes in Khayelitsha, a township near Cape Town, has shown that only 12 percent of patients who started treatment three years ago needed second-line drugs, but the report cautioned that an increasing number of HIV-positive people would inevitably develop resistance to first-line treatments. According to MSF, the high prices of second-line medications mainly stemmed from a lack of competition. For example, Kaletra - an expensive combination of lopinavir and ritonavir that is part of South Africa's second-line treatment regimen - is only manufactured by the international drug company, Abbott Laboratories. A generic equivalent of Kaletra is in production but has yet to be approved. "If manufacturers don't have competition, prices remain high," said Darder, noting that the government had an obligation to ensure competition in the ARV market. While generic production had brought down the prices of most first-line antiretrovirals from over US $10,000 in 2000 to as little as US $150 per patient per year in June 2004, MSF pointed out that not all countries were able to benefit from these lower prices because of patent barriers to accessing generic versions. Gordon Mthembu, the Gauteng provincial chairperson of Treatment Action Campaign (TAC), an AIDS activist group, told PlusNews, "We expect the government to force pharmaceutical [companies] to license generic drug manufacturers to produce drugs that are part of second-line treatment." Another reason for the dramatic price differences between first- and second-line drug regimens was the Indian Patents Act, passed earlier this year. As a member of the World Trade Organisation (WTO), India has had to amend its patent laws to bring them in line with the Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement. This meant that India, one of the world's biggest generic drug producers, now had to recognise patents on medicines, which could result in the patent-holder being the only producer of newer drugs. In the absence of competition, this sole supplier could set the price. MSF found that some single-source drugs remained very expensive in developing countries, and many pharmaceutical companies did not offer discounted prices in countries defined by the World Bank as "middle-income", such as South Africa, Swaziland and Namibia. MSF noted that there were exceptions to these income-related restrictions: pharmaceutical giants Gilead and Bristol-Myers Squibb recently extended their discounted prices to some "middle-income" countries and GlaxoSmithKline now offered its discounted products to all Global Fund recipient countries. Another challenge to accessing treatment was that companies did not always market their full range of ARVs in all the countries eligible for cheaper ARVs. MSF said its ARV programmes had experienced problems in getting cheaper medication and, in many cases, even in the world's poorest countries, such as Mozambique or Cambodia, the organisation had had to buy some of their drugs in neighbouring countries. The report slammed drug firms for making the purchase of lower-priced products "too complex". Roche's discounted products had to be ordered from Basel in Switzerland, for example, and paid for in Swiss francs, making it very difficult for developing countries to purchase them. To access the report: www.doctorswithoutborders.org