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HIV AIDS

Introduction to HIV/AIDS

Need for Newer Drugs

: © Francesco Zizola / Noor

“We are seeing a major crisis looming for people living with HIV/AIDS in the developing world. As doctors, we are deeply concerned to avoid the situation of the late 1990s, when people faced a death sentence because they could not afford the life-saving medicines widely available in rich countries.” Dr. Tido von Schoen-Angerer, Executive Director, Campaign for Access to Essential Medicines.

The need to switch treatments
As people on antiretroviral treatment (ART) develop intolerable side effects or start to develop resistance to their first set of antiretroviral medicines (ARVs), they need to switch to a different drug combination. Resistance is a process that develops naturally and is inevitable for people who have been on treatment for a certain amount of time.

In one of MSF’s long-standing HIV/AIDS projects, in Khayelitsha, South Africa, one in five patients needs to be switched to ‘second-line’ therapy after five years of treatment. Indeed, in wealthy countries, many people living with AIDS have changed their treatment lines four, five or even six times. With two million people on ARVs across the developing world, the need for access to newer ARV options is growing rapidly.

The need for less-toxic regimens
Further, the World Health Organization has recommended that a newer, less-toxic drug, tenofovir, be used in first-line treatment. This is intended to help avoid the side effects some people suffer from one of the primary drugs used in today’s most widely-used combination, stavudine.

It is crucial that people receive the best possible and least-toxic treatment from the start: this ensures that people are able to stay on that combination for as long as possible before needing to switch. This is especially important when there are few drug options to switch to, as is the case in developing countries, and because the second and further treatment combinations have less chance of success.

The skyrocketing cost of newer drugs
The price of these newer drugs, however, is dramatically higher than the cost of the older ones. As an example, in some countries it can cost between 10 to 20 times more to treat a patient with second-line drugs than the cost of treating them with first-line drugs. And to provide patients with a less-toxic first-line combination raises the cost of treatment five fold.

There is a real risk that patients will again be faced with a situation where treatment is priced out of reach.