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Last Updated: Friday, 21 November, 2003, 12:52 GMT
The HIV drugs battle

By Karen Allen
BBC Health Correspondent

More than six million people living with HIV in the developing world need the potent drugs which can significantly extend their lives, but only 300,000 receive them.

Anti HIV drugs
Put your questions on anti-HIV drugs to our panel:
  • Dr Harvey Bale Jr, head of International Federation of Pharmaceutical Manufacturers Association
  • Dr Mohga Kamal-Smith, Health Policy Adviser, Oxfam
  • Dr Ernest Darkoh, head of Botswana antiretroviral drug programme

  • Ninety-five percent of the 42 million people worldwide who are infected with the virus which causes Aids live in poor countries.

    As more of these people reach the point where their infections require the treatments - known as antiretroviral drugs - demand will increase further.

    But few will be able to afford the medicines.

    Progress is being made to bring the drugs to poor nations, but it is slow.

    Since 2000 when the inequity of access to treatment forced its way onto the international political agenda, some pharmaceutical companies have reduced the prices of the drugs.

    The price of antiretroviral treatment has fallen from £6,000 per patient per year to £180. Even so, that is still beyond the means of millions of people who survive on less than a dollar a day.

    Alliances are being forged with politicians, international agencies and businesses to try to push forward the production of "generic" or copy antiretroviral drugs.

    Agencies are also striving to provide the back-up medical training and clinics to enable patients to take the drugs safely and effectively.

    Trade deal

    The Bill Clinton Foundation - an HIV/Aids charity - recently signed an agreement with generic drugs manufacturers to offer two key drugs at half the cost of "named" antiretroviral drugs to countries like Mozambique, Rwanda, South Africa and Tanzania.

    Pharmacist David Gitindi restocks Aids drugs, Princess Mariba hospital, Gaborone

    However, agencies like Oxfam worry that initiatives like these will run into trouble in 2005, when developing countries lose their automatic right to produce generic medicines.

    Many do not dare to exercise this right at the moment because they are either afraid of the political repercussions or do not have the technology.

    A deal singed in August 2003, just before the World Trade Organisation meeting in Cancun, tried to refine trade agreements that protect patents and scare off poorer countries from manufacturing copies of drugs.

    Cheap copies

    The WTO deal would allow developing nations to import low cost copies of brand name drugs by issuing a compulsory license.

    However many aid agencies fear that the deal is bureaucratic and still puts far too much power into the hands of the big pharmaceutical giants.

    Family of Aids orphans, Kakalo village, Ndola, Zambia
    The WHO hopes 3 million more people will get the drugs by 2005
    They say it will apply to only a limited number of drugs and it will not allow for the quantities of copy drugs needed to deal with the HIV/Aids pandemic.

    Countries like India, South Africa, Thailand and Kenya all have the capacity to develop copies of drugs.

    Many commentators see them as holding the key to the drugs debate if the issue about patents can be resolved.

    Indeed the World Health Organisation hopes to build on this capability to deliver on its promise to provide 3 million more people with aids treatments by 2005.

    Drug-resistant strains

    For richer countries like Britain, HIV/Aids may now be considered a chronic disease rather than a death sentence because of the availability of antiretroviral drugs, but it too has its problems.

    Patients who have been on antiretroviral drugs for some time are beginning to develop resistance to them.

    Their treatment options are running out. And worryingly doctors in Britain are beginning to see drug resistant strains of the virus being transmitted from person to person.

    Fuzeon works by preventing HIV from infecting the body's immune cells

    New classes of treatment are coming on stream which scientists hope may get round the resistance problem.

    But these classes of drugs called fusion inhibitors - for example Fuzeon - are expensive and complicated to use.

    Unlike conventional antiretroviral drugs, they work by preventing the HIV virus from entering a cell in the first place.

    Put simply - doctors believe that because of this unique way of working, patients may be less likely to become resistant to them.

    The challenge to deliver aids drug treatments is a race against time - the virus is constantly mutating and one person is infected every 14 seconds.

    Although more medicines will certainly make a difference to the harrowing death toll, scientists are looking at other options like microbicides, better prevention strategies and ultimately - a vaccine.

    The following comments reflect the balance of views we received:

    The number of Aids patients will increase much faster than the ability of anyone or any country to fund its treatment. Therefore, unless an efficient, stern and rapid prevention is carried out, it'll be a futile battle against Aids.
    N Boon Huat, Seremban, Malaysia

    Those who want the drug industry to function as a charity instead of a business should start funding a charity
    George Blank, Denville

    The attempt to be generous at someone else's expense has already had pernicious effects. Drug companies have been concentrating research in lifestyle drugs for rich people because social initiatives make it difficult to recover research expenditure on drugs that mainly affect the poor, particularly in countries that ignore or bypass patents. Drug patents only last 17 years, and much of that period passes before the drug is even available for use. I would not want to see current drugs made available at the expense of developing future drugs. That could include trading the ability to live longer with HIV for a cure. Those who want the drug industry to function as a charity instead of a business should start and funding a charity. Then research could take place without requiring the profit motive.
    George Blank, Denville, NJ, USA

    If your intention is simply to save lives then the current selection of drugs will have no affect whatsoever as they do not cure Aids - they merely delay the inevitable. Arguably they cause more deaths by allowing the patient to spread the disease over a longer period. Set against this, you have the possibility of developing a cure for Aids in the future. If this happened then all those who had been kept alive by the current drugs could be cured. Therefore, ultimately, your opinion of whether it is worth spending money on the current drugs as opposed to research into better drugs or, even, better sewers and cleaner water, depends on how optimistic you are about a cure being found soon. Personally, I'm fairly pessimistic.
    Richard Crawford, Manchester, UK

    To Richard Crawford: You refer to a cure as delaying the inevitable. I am afraid all death is inevitable; it is only a matter of how much time you have. HIV is decimating the working populations of many parts of Africa, to the point that there is no possibility of an economic recovery. It is an unending cycle. Prolonging life and providing education offers some hope that things will improve.
    Dwight Kulkarni, Toronto, Canada

    Whereas the market fails to allocate the resources effectively, there is a potential role for the governments and the international organizations. This is perhaps a chance for the governments if the developed countries to take measures to make the technology more available and to give more incentives in this area.
    Qian Xiaofeng, China

    Health in developing nations is much more than handing out pills. Clean water, nutrition, shelter and public hygiene are much more important in saving lives.
    Alex van Deelen, The Hague, NL

    I work with Aids victims in a border area of a developing country. There is the possibility that the cost of ARVs will come down to an affordable level for some people (not for many). However we have enough trouble doing short term DOT therapy for TB because of the unstable nature of border people who can often not be followed up. How have others in border type situations helped people who can get ARV drugs to actually take them and prevent resistance?
    Jane Fucella, Sangklaburi, Thailand

    The HIV/Aids drug battle is not always about money. Some drug companies have offered at least some of the best drugs free for prevention of mother to infant transmission in developing countries. Yet there are organized groups of denialists who attempted to convince the government of South Africa not to participate in these programs. These groups variously claim that HIV does not exist, or that HIV is harmless and that Aids is a "lifestyle" disease.
    Brian Foley, PhD, Los Alamos, NM, USA

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