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Poor priced out of market for life-saving drugs

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Millions of HIV sufferers are being denied life saving treatments because patents are stifling competition and pushing costs well out of the reach of the world’s poor, according to international medical humanitarian organisation Medecins Sans Frontieres.

In a report released at an International AIDS Society conference in Kuala Lumpur early this month, MSF found that the price of first and second-line HIV drugs had plunged because of intense competition between rival generic medicine manufacturers, putting them increasingly in reach of the estimated 34 million people worldwide living with the disease – 70 per cent of whom are in sub-Saharan Africa.

According to MSF, in the past year alone the annual cost of treatment with the first-line pill recommended by the World Health Organisation – a combination of tenofovir, lamivudine and efavirenz – has fallen by an average of 19 per cent to $139 per person, with several countries able to secure even larger discounts through bulk purchases.

The emergence of new generic pharmaceutical manufacturers has also helped drive even sharper falls of close to 30 per cent in the price of the two key second-line treatments – with the cost of one plummeting by 75 per cent since 2006.

But, despite these declines, the cheapest second-line treatment is still more than double the price of first-line treatments, and MSF has warned that newer antiretroviral therapies still under patent remain at astronomically high and unaffordable prices.

MSF Medical Director Dr Jennifer Cohn said it was “good news that the price of key HIV drugs continue to fall as more generic companies compete for the market, but the newer medicines are still priced far too high”.

The latest HIV drugs are needed to treat patients whose infection has not responded to the first and second-line therapies.

But the desperately needed new HIV medicines, including critical new classes of antiretrovirals,  are extremely expensive because patents protect them exposure to competition, according to MSF.

The best combination of medicine for people who have failed first and second-line treatments costs more than $2000 a year per person in the world’s poorest countries.

In some nations, including Jamaica and Thailand, just one of the four components making up such drugs cost up to $6570 a year for each patient.

In addition to these concerns, health workers are worried that reliance on new generation HIV therapies will intensify as increasing use is made of a broader range of drugs in the first and second lines of defence against the infection.

HIV experts claim that well-tolerated drugs, such as the integrase inhibitor dolutegravir, may be used in the future in first and second-line treatments, making affordable access to newer drugs even greater priority.

According to MSF, treating the millions infected with HIV will increasingly depend on the bringing down the price of newer drugs.

HIV pharmacist at MSF, Arax Bozadjian, said that “today there are no quality-assured generic options for a large majority of the newer HIV drugs,” Ms Bozadjian said, warning that this was not simply a problem for the world’s poorest nations.

“Prices in middle-income countries are also of major concern,” she said, adding that many had little  access to much-needed regimens because they were excluded from existing voluntary agreements.

Much of the fall in the cost of first and second-line combination HIV drugs has been attributed to the proliferation of generic drug manufacturers in India.

But industry observers are concerned that, with newer HIV medicines being patented at an increasing rate, it will be vital to find a solution to tackle the high-price problem.

In a study presented to the conference, Australian researchers provided evidence that

A reduced daily dose of one antiretroviral drug is just as effective – and much cheaper – than the current recommended treatment regime.

Professor Sean Emery from the University of New South Wales’ Kirby Institute said health authorities and patients could save up to $20 per person each year from the cost of HIV medication by using reduced doses of the drug efavirenz, which is currently used as part of combination antiretroviral therapies that cost up to $75 a year per patient.

“We’ve been able to show, with some very robust data, that it is possible to administer a reduced daily dose of [efavirenz] to people with HIV…in a way that doesn’t affect the ability of that drug to save their life, and it’s also associated with some reduced side effects,” Professor Emery told ABC radio.

In a separate report to the Conference, MSF examined the cost of viral load tests, which are considered the “gold standard” for monitoring HIV treatment in developing countries. The WHO has recommended their widespread use, but price and complexity have so far slowed the roll out of these and other diagnostic technologies.

“Viral load testing is the best way to keep people on the most affective and affordable treatment for as long as possible,” Dr Cohn said. “With the price of second-line treatments coming down, it’s really time to start testing people’s viral load, and making sure people are on a treatment that works for them, instead of waiting until its too late and they get sick again or even die.”

Jeremy Mole