Untangling the web of antiretroviral price reductions

MSF's Campaign for Access to Essential Medicines first published a report on AIDS drug prices in 2001, in response to the lack of transparent information available for treatment providers to be able to make informed purchasing decisions. MSF, along with others providing HIV/AIDS treatment in developing countries, continue to struggle with affordability, availability and adaptability of antiretroviral drugs (ARVs). Now its 11th edition, "Untangling the Web of Antiretroviral Price Reductions" provides a window into the evolution of ARV prices since 2001 and sheds light on the continuing gaps in treatments needed for patients in developing countries. Among the key findings of this edition: New classes of drugs - but not developed with needs of patients in developing world in mind For the first time, this edition of UTW contains some of the very newest drugs developed to fight the HIV virus with quite new mechanisms, offering people living with HIV/AIDS many more treatment options. However, few of these drugs have been developed taking into account the specific needs of patients in developing countries - such as women of childbearing age, children, and people who need to be able to take drugs for other conditions such as tuberculosis or malaria at the same time. The companies that are producing these drugs furthermore have not even provided prices for developing countries, which shows you how far away we still are from being able to get these drugs to people in resource-limited settings. The access gap still remains huge between people in wealthy and developing countries. Higher prices for newer ARVs The most affordable first-line antiretroviral fixed-dose combination (3TC/d4T/NVP) now costs US$87 per patient per year down from US$10,000 per year in 2001. But with the growth of resistance to first-line drugs and the need to switch patients because of drug toxicity, newer ARVs are needed and these cost a great deal more. For instance, the WHO now recommends that treatment providers move towards a less toxic first-line drug regimen based on the drug tenofovir - which has been standard in the West for five years - but this has considerable price implications, ranging from double the price of the most used first-line regimen to up to 11 times that price in countries that cannot access generic versions of the drug due to patent protection. For those patients who need to be switched to a "second-line" treatment because of resistance, the price jump is a lot greater. For patients who need a "second-line" treatment regimen, the price jump is a lot greater. The increase ranges from nine-fold to up to 17-fold in some "middle-income" countries where the drugs are patented and treatment providers must buy the product from the originator company. Paediatric treatments still an "afterthought" As for paediatric treatments, unfortunately, children continue to be an afterthought when it comes to producing appropriate formulations of medicines. Of the 22 ARVs approved by the U.S. Food and Drug Administration, eight are not approved for use in children and nine do not come in any kind of paediatric formulation. And when versions for kids do exist, they are often not adapted for use in resource-limited settings, meaning they are powders requiring reconstitution with water, or syrups, both which may need refrigeration, for which access can be limited in developing countries.