Untangling the Web of Antiretroviral Price Reductions (16th edition) | Médecins Sans Frontières (MSF/ Doctors Without Borders)
▻http://www.msf-seasia.org/14807
Today at the International AIDS Society conference in Kuala Lumpur, Médecins Sans Frontières (MSF) launches two reports: the 16th edition of Untangling the Web of Antiretroviral Price Reductions, MSF’s report on price and access issues around antiretrovirals (ARVs), medicines used to treat HIV; and Putting HIV Treatment to the Test: A Product Guide for Viral Load and Point-of-Care CD4 Diagnostic Tools
This year’s edition of Untangling the Web finds that although the price of first- and second-line ARVs have come down thanks to increased generic competition, third-line or salvage regimens remain exorbitantly priced, with middle-income countries such as Armenia paying more than US$13,000 per person per year for raltegravir, just one of the three or four drugs needed in a third-line cocktail. MSF also finds that while patents remain a barrier on newer drugs and in middle-income countries, some countries are using World Trade Organization-sanctioned TRIPS flexibilities to issue compulsory licences to allow more affordable access. Voluntary licences, however, are the preferred method by originator companies of selling new, patented ARVs to countries, but those companies are increasingly excluding all but least-developed and sub-Saharan African countries from their licences. Free trade agreements are also increasingly posing a threat to access to medicines in negotiating countries, with the EU-India Free Trade Agreement and the Trans-Pacific Partnership Agreement causing the most concern over proposed harmful provisions.
MSF’s pricing analysis also extends to viral load monitoring tests in Putting HIV Treatment to the Test. Routine evaluation of a person’s viral load is important because it helps to identify who needs help in adhering to ART. Where adherence problems can be ruled out and treatment failure has already occurred (because drug resistance mutations have developed), viral load can help guide a switch to second-line treatment. Viral load can help prevent viral transmission, because non-viraemic patients (people with ‘undetectable’ viral load) have a very low risk of transmitting HIV. Viral load is a much more accurate way than the commonly used CD4 count to determine how well someone is doing on treatment, potentially an avoiding unnecessary switch to more expensive second- or third-line treatment. However, current viral load tests are expensive and complex for remote and resource-limited settings. Putting HIV Treatment to the Test looks at these issues on a number of viral load and point of care CD4 diagnostic tests.
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