Care and support for people living with HIV/AIDS

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Care and support for people living with HIV/AIDSTable 2. Price (US$) of a defined daily dose of selectedantiretrovirals in five countriesDrug Defined dailydoseUSA (1) Côte d’Ivoire (2) Uganda (3) Brazil Thailand (6)zidovudine100 mg600 mg 10.12 2.43 4.34 1.08 (4) 1.74didanosine100 mg400 mg 7.25 3.48 5.26 2.04 (4) 2.73 (7)stavudine40 mg80 mg 9.07 4.10 6.19 0.56 (4) 0.84indinavir400 mg2400 mg 14.93 9.07 12.79 10.32 (5) NAsaquinavir200 mg1200 mg 6.50 4.82 7.37 6.24 (5) NAefavirenz200 mg600 mg 13.13 6.41 NA 6.96 (5) NA(1) Prices, 2 April 2000, from www.globalrx.com, a US mail-order pharmacy that offers proprietary antiretroviralswith a minimum mark-up (shipping not included).(2) End-user prices, UNAIDS Drug Access Initiative, Côte d’Ivoire, March 2000.(3) End-user prices, UNAIDS Drug Access Initiative, Uganda, March 2000.(4) Generic drugs produced in Brazil (US$1 = R$ 1.8).(5) January 2000 cost to the Brazilian Government of imported drugs (US$ 1= R$ 1.8).(6) Generic drugs produced by Government Pharmaceutical Organization, Thailand (US$ 1 = 38 baht).(7) 115 mg powder formulation, equivalent to 100 mg tablet.Box 18. Experience in Brazil with generic alternatives toproprietary antiretroviralsThe Government of Brazil has a policy of universal access to antiretroviral drugs thatcurrently benefits nearly all AIDS patients in the country (about 85 000). The introductionof combination antiretroviral therapy nearly halved the annual number ofAIDS deaths between 1996 and 1999 and reduced the incidence of opportunisticinfections by 60-80% over the same period.The universal access programme would not have been possible without significantdecreases in the cost of antiretroviral drugs. The Government decided to start localmanufacture of drugs that were not patent-protected, and for which it had the know-–––>101
Report on the global HIV/AIDS epidemic – June 2000how and infrastructure. Local production, combined with bulk purchases of importedantiretrovirals, led to significant decreases in the programme’s drug costs. Theannual cost of double therapy with nucleoside analogues decreased on average by80% between 1996 and 2000, from US$ 3812 to US$ 763. For triple therapy with twonucleosides and one protease inhibitor, the cost reduction was 36% over the sameperiod (from US$ 7342 to US$ 4717) and for triple therapy with two nucleosides andone non-nucleoside it was 34% (from US$ 4584 to US$ 3009).The programme’s annual drug costs were approximately R$ 611 million (US$ 339million) in 1999, and are expected to rise to R$ 831 million (US$ 462 million) for theyear 2000, taking into account both a higher proportion of patients on triple therapyand a larger overall number of patients. Between 1997 and 1999, approximately146 000 AIDS-related hospitalizations were averted, resulting in savings of approximatelyR$ 521 million (US$ 289 million); this has partly offset the high cost of antiretroviraltherapy. At the same time, condom sales increased by nearly half (from 216million to 320 million pieces) between 1996 and 1999, and demand for voluntary HIVcounselling and testing rose 35% between 1996 and 1998.Yet another approach is to utilize a safeguard incorporated into the Agreement onTrade-Related Aspects of Intellectual Property Rights (TRIPS), an international treatythat protects patent rights, including those for drugs. Patent protection provides animportant incentive for innovative research and development of new HIV/AIDS drugsand, hopefully, the discovery of HIV vaccines, in particular, vaccines suitable for usein developing countries (see Box 14, page 68).The TRIPS agreement sets out minimum standards in relation to intellectual propertyfor Member States of the World Trade Organization (WTO). Countries that wish to bemembers of WTO must comply with the TRIPS standards, where necessary bychanging their national laws and regulations. In practice, for many developing countries,this will mean giving patent protection for the first time to pharmaceuticalinventions (both products and processes). Under TRIPS, patent protection must beavailable for a minimum period of 20 years. However, the TRIPS agreement alsoforesees that in certain circumstances, such as national emergencies, governmentsmay grant third parties the right to produce and sell a patented product even withoutthe consent of the patent holder, according to carefully prescribed conditions.This safeguard, known as “compulsory licensing”, was incorporated into the TRIPSagreement through negotiations by developing countries. Its maintenance as part ofTRIPS has been vigorously defended by nongovernmental organizations and activistgroups, such as Act Up, the Consumer Project on Technology and Médecins SansFrontières, who have conducted international campaigns for improved drug access.These organizations have also sought to obtain compulsory licences on drugs ofinterest to people with HIV/AIDS in South Africa and Thailand. The campaigns didnot result in the issuing of compulsory licences. However, access to the target drugs102
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Care and support for people living with HIV/AIDS

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