Action needed to avert AIDS 'treatment time bomb'

JOHANNESBURG, 28 July 2009 (PlusNews) - The goal of achieving universal access to treatment by 2010 has preoccupied the global AIDS community in recent years, but a new report warns that not preparing for the changing treatment needs of people living with HIV will doom the sustainability of treatment programs in developing countries.

Over the next decade an increasing number of patients on inexpensive first-line antiretroviral (ARV) drugs in low-income countries will need second-line ARVs, which currently cost at least seven times more. Many patients will also need to be switched to newer, less toxic first-line drugs, which have fewer side-effects but are at least double the price.

'The Treatment Timebomb', released this month by the All Party Parliamentary Group (APPG) on AIDS, a group of United Kingdom MPs, argues that action is needed now to bring down the price of second-line and less toxic first-line ARVs if a crisis is to be averted later.

'We must not sleepwalk into a situation where treating even a small proportion of those with HIV is unaffordable,' warns the report, which summarised the findings of a five-month inquiry into long-term access to antiretroviral (ARV) medicines in the developing world.

Low-income countries can afford to buy older-generation ARVs largely because multiple manufacturers are producing generic versions of them at a fraction of the original cost, but most of the newer drugs are being produced under patents that prevent generic manufacture.

The AAPG report points out that safeguards in the World Trade Organization's Trade Related Aspects of Intellectual Property Rights (TRIPS) allow countries to override patents - for public health purposes - by issuing 'compulsory licenses' that enable the generic manufacture of drugs still under patent.

However, few developing countries have exercised this right, citing a lack of capacity and legal know-how to negotiate the complicated paperwork required, and political pressure from foreign governments.

The authors of the report support an alternative approach that would see pharmaceutical companies putting their ARV patents into a single pool, from which manufacturers or researchers could draw in exchange for a royalty fee.

They argue that patent pools, an initiative of UNITAID, an international facility set up to purchase high volumes of HIV/AIDS, malaria and tuberculosis drugs at low prices, not only have the potential to reduce the price of existing ARVs, but to stimulate the production of urgently needed new medicines and formulations, such as paediatric ARVs and fixed-dose combinations.

Despite political pressure from over 100 UK MPs who signed a parliamentary petition, no pharmaceutical company has so far agreed to put its ARV patents into a pool, but Nathan Ford, head of the medical unit of international medical NGO, Médecins Sans Frontières (MSF), in South Africa, said the use of parliamentary channels to promote a cause previously only championed by NGOs was a positive development.

'The problem is AIDS treatment requires a range of drugs, so if some companies play ball and others don't, the net result may be that second-line treatment will still be more expensive,' he told IRIN/PlusNews. 'It's really important that all companies engage in a solution.'

An editorial on patent pools in the British medical journal, The Lancet, on 25 July, said the mechanism 'could create a win-win situation', but the AAPG report would need to be backed by political clout for drug companies to come on board.