Face reality of drug resistance, warns MSF

Medical humanitarian organisation, Medecins Sans Frontieres (MSF), continues to be the lone voice sounding the alarm about the cost and availability of newer AIDS medicines in developing countries. Several speakers at the start of the International AIDS Conference in Toronto this week, suggested that the cost of AIDS drugs is no longer a major barrier to access. "It is deeply concerning that according to UNAIDS, WHO [the World Health Organization] and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the access to medicines struggle is over," said Nathan Ford, advisor to MSF's Access to Essential Medicines Campaign. While generic competition has driven down the cost of first-line antiretroviral (ARV) drugs to under US$140 per patient per year, greater enforcement of patent protection means that newer drugs needed for second-line treatment are not available from generic manufacturers. According to MSF, the patent-holding drug companies are failing either to register new drugs in developing countries or to offer them at prices governments can afford. Patients need second-line drugs when they develop resistance to first-line regimens, something that occurs when patients miss doses. At an MSF-supported programme in the South African township of Khayelitsha, 16 percent of patients need to switch to second-line drugs after four year; they currently cost five times more than first-line regimens. Ford described the level of resistance in Khayelitsha, a programme that has been running for longer than most other treatment programmes in the region, as "a window into the future". "If you're seeing those levels of resistance in Khayelitsha, a programme with very strong community peer support, clinical supervision and viral load monitoring, and a quite sophisticated way of measuring adherence, then you have to consider resistance as an unavoidable part of any treatment programme," he said. Speaking at the Toronto AIDS conference, Ibrahim Umoru, an MSF peer educator from Lagos, Nigeria, described his personal experience of having to interrupt his ARV treatment because he could no longer afford the drugs. He developed resistance shortly after re-starting treatment but was one of a small minority able to access second-line drugs through an MSF programme. "Most patients whose lives had been saved by first-line treatment will be abandoned the moment they need second-line drugs unless governments pull their heads out of the sand and start tackling this issue," he said. According to MSF, most of the drugs recommended in WHO's new ARV treatment guidelines for resource-poor settings, released at the conference, are either unavailable or unaffordable in developing countries. "We need this problem to be taken up at a higher level," said Ford. "Organisations like the Global Fund need to be thinking about this now or they will be bankrupt in a matter of years."