New drugs urgently needed

The lack of newer AIDS drugs in Africa could jeopardise the lives of people already receiving the treatment, medical humanitarian organisation Medecins Sans Frontieres (MSF) has warned. With many countries on the continent embarking on national programmes to provide antiretrovirals (ARVs), the first-line drug regimen has become cheaper and widely available. But as resistance to the basic drugs inevitably builds up, there will be a need for a second generation of drugs within a few years. 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 most African treatment programmes are still in their early stages, few HIV-positive patients have thus far developed resistance. But Dr Eric Goemaere, the head of MSF in South Africa, warned against complacency at an international conference on AIDS and Sexually Transmitted Diseases in Africa (ICASA), in Abuja, Nigeria, last week. "It's a common phenomenon linked to the mutation of the retrovirus: after having taken the drugs for more than four years, patients develop resistance. This is already a problem for 17 percent of people on ARV treatment in [MSF's project in] South Africa, and will become the rule in the next few years," he told PlusNews. In Senegal, one of the first countries in Africa to provide the life-prolonging medication to HIV-positive people, about 10 percent of people on ARVs are in need of second-generation drugs, according to Professor Papa Salif Sow, head of the infectious diseases service at Dakar's Fann hospital. "That is the fear which accompanies every treatment programme. When a programme gets old, a new generation of drugs has to be available - that is going to be the rule everywhere now," he said. MSF charged that although the newer drugs were urgently needed in Africa, they were not available because international pharmaceutical companies were choosing not to sell them. For example, Abbott Laboratories, the sole manufacturer of Kaletra - an expensive combination of the second-generation drugs, lopinavir and ritonavir - recently launched a new formulation of the medication, which, unlike the old one, does not require refrigeration. Although this new version would be very useful in most African settings, MSF pointed out that it was not available on the continent. Price remains a major obstacle. According to the provisional results of a study conducted earlier this year in Burkina Faso by the Association Action Santé (AAS), treating a patient with second-generation drugs cost US $919 per year, while treatment with the first-line ARVs only cost $270. In South Africa, MSF pays $194 per patient per year for standard first-line therapy, while a newer, second-line treatment is eight times more expensive at $1,661 per patient per year. "If we don't have access to new drugs at a fair price, the outcome will be disastrous for Africa," Goemaere cautioned.