Medicines Sans Frontieres Presents Data Showing Antiretroviral Therapy Can Improve Survival in Developing Countries
Administering antiretroviral drug treatment to people with HIV/AIDS in developing countries can "dramatically increase survival," according to a study presented by Medicines Sans Frontieres Monday at the XV International AIDS Conference in Bangkok, Thailand, Reuters reports (Reaney, Reuters, 7/12). MSF examined data from its treatment programs in 16 countries -- which include 12,000 people living with HIV/AIDS -- according to the Boston Globe. About 40% of patients enrolled in the programs were given a prognosis of one year to live because their CD4+ cell levels were below 50 cells per mm3. After one year of treatment, the median increase in CD4+ cell counts across all patients was 135; after two years, the median increase was 208, according to the report. The report shows that patients taking antiretroviral drugs had a two-year survival rate of 85.3%, the Globe reports (Donnelly, Boston Globe, 7/13).
Although the cost of first-line antiretroviral drug regimens has dropped significantly, MSF said that more antiretroviral drug price reductions are needed to help counter the cost of second-line treatments, Reuters reports. MSF provides treatment for 13,000 people in 25 countries, and most participants receive first-line drugs, according to Reuters. Some drug makers have reduced the prices of their antiretroviral treatments by up to 90%, and the cost of fixed-dose combination generic treatments cost about $200 per person, per year, MSF said, according to Reuters. However, if a patient develops resistance to these medicines and moves to the second-line treatment, the price increases to $5,000 per patient, per year. Dr. Alexandra Calmy, an HIV/AIDS adviser for MSF, said, "Unless this situation changes, per-patient costs will skyrocket and people will die needlessly" (Reuters, 7/12). MSF spokesperson Kris Torgeson said that there is "still ... not enough being done to rapidly scale up access to treatment for all those who need it" (Collins, VOA News, 7/12).
MSF officials on Tuesday said that treating HIV-positive children in developing countries is an "uphill battle," Reuters reports. MSF said that there are about 2.5 million HIV-positive children in the world and about 700,000 new HIV cases during the last year. About 50% of HIV-positive children die from AIDS-related causes before age two, MSF said. Dr. David Wilson, medical coordinator for MSF in Thailand, said, "Up until now [children] have been a discriminated minority," adding, "We need to pay more attention to them. They are not just small adults. There are specific issues in terms of diagnosis and specific terms of treatment" (Reaney, Reuters, 7/13). According to BBC News, standard tests to determine a patient's HIV status are unreliable in infants younger than 18 months, and monitoring drug treatment also is difficult in children because most commercially available machines that check CD4+ cell counts are not adapted for use in children (BBC News, 7/14).
Treatment Cost and Access for Children
Antiretroviral drug treatment for children currently costs "several times more" than adult treatment, according to SAPA/AllAfrica.com. According to MSF, antiretroviral treatment in pediatric formulations -- oral solutions and syrups -- is about $1,300 per patient, per year, compared with about $200 per adult patient, per year. Pediatric drugs also are not available in fixed-dose combinations. In addition, the drug zidovudine costs about $1,200 per adult patient, per year, compared with about $2,846 per child patient per year (SAPA/AllAfrica.com, 7/14). Fernando Pascual, an MSF pharmacist, said that HIV incidence among children is "neglected by [drug] companies," adding, "They will not produce formulations for children unless there is pressure from the international community" (Reaney, Reuters, 7/13). Children also do not have access to treatment programs because medical staff are not adequately skilled, according to MSF official Arnaud Janin. In Malawi, 45,000 patients receive antiretroviral drugs -- none of whom are children -- and only 5% of the 13,000 patients whom MSF have put on its antiretroviral program are younger than age 13 (Agence France-Presse, 7/14).
Dr. Omokhudu Idogho of Action Aid Nigeria said he is calling upon African countries to develop policies that would require 30% of pharmaceutical companies' budgets to be set aside for producing pediatric drugs. "Apart from South Africa, most African countries do not have the capacity for mass production," Idogho said, adding, "Therefore, we must move fast because European and American pharmacies do not feel the pressure to produce the drugs for us. If we don't produce them fast enough, then we're going to lose more lives" (SAPA/AllAfrica.com, 7/14). Thai health officials recently announced that it will launch a pediatric version of its generic combination antiretroviral drug next year to simplify the treatment of HIV-positive children, according to the Government Pharmaceutical Organization. According to GPO Managing Director Thongchai Thavichachart, the drug is currently in clinical trials and the agency hopes to have it available by the middle of next year. The GPO-VIR drug combines generic equivalents of stavudine, lamivudine and nevirapine but is currently only available to patients who are at least age 10. Patients younger than age 10 either have to take powder or liquid formulations or split the tablet. Thongchai said that there are currently about 5,000 Thai children with HIV who need antiretroviral treatment (Reuters, 7/14).