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Urgent action needed to defuse HIV treatment timebomb
Newsdesk
1 year before the G8 target of universal access to antiretrovirals (ARVs), only a third of those in need are receiving medication. With the HIV pandemic continuing to spread dramatically, an inquiry by the UK all-party parliamentary group on AIDS “shows that we are sitting on a treatment timebomb”. Action is needed now, to avert crisis later, says the report, which predicts that over 50 million people worldwide could need ARVs by 2030. The International AIDS Society has applauded The Treatment Timebomb report. Society president Julio Montaner explains that suppression of viral load reduces transmission rates of both HIV and tuberculosis to the wider community. “The more you treat, the more lives are saved, the more families are protected, the more people can go back to work”, he says. But, universal access to ARVs “is not just the humanitarian, ethical, or costeffective thing to do”, he continues. “It is cost-averting”, and vital especially in times of fiscal crisis. Most importantly, he stresses, universal ARV coverage is an essential part of the solution to control and reduce the spread of HIV, which is a millenium development goal for 2015. The UK International Development Minister Mike Foster told TLID that “we must think ahead when it comes to HIV treatment. The number of people needing treatment, and more complex and expensive treatments, will continue to rise. The price of those treatments is an issue now, and will only grow bigger in the future.” The report notes that, in some countries, access to therapies to prevent vertical transmission is particularly poor, whereas treatment for adults and children is often started late on the basis of symptoms, because of the lack of CD4 count testing. Revised WHO guidelines due to be released later this year are expected to raise the CD4 count at which to begin treatment, which will mean more people will be www.thelancet.com/infection Vol 9 October 2009
immediately eligible for ARVs. Effective treatment will increase lifespan, and thus more people will need drugs for longer, but effective treatment is a key part of the strategy to eliminate HIV, says Montaner. “We need to get policy makers to understand this”, he urges. The UK all-party parliamentary group is calling for immediate action and long-term plans by countries and donors, including secure financial commitments to ensure continued ARV supplies and bulk ordering to reduce costs. Stakeholders need to work together to decide the optimum balance of spending between treatment and other prevention efforts, the report recommends. Cheap CD4 tests are also urgently needed to guide treatment. Poor adherence, interrupted drug supplies, and counterfeit drugs increase the likelihood of resistance, which necessitates newer ARV regimens. Notably, adherence and cost-savings can be substantially improved by use of generic fixed-dose combinations. However, the World Trade Organization is tightening rules on patenting and so reducing new generic drug production. Foster points out that the UK Department for International Development is working with manufacturers to lower the price of drugs, and supports the initiative by UNITAID to develop an ARV patent pool. In principle, companies will pool their patents, which are then available for license—eg, to generic manufacturers—in return for a royalty payment. Voluntary licensing schemes already exist but via individual companies, whereas the UNITAID patent pool would be a “one stop shop”. Ellen ’t Hoen, UNITAID, Geneva, Switzerland advises that the patent pool will overcome many obstacles, especially to rapidly produce new fixed-dose combinations and urgently needed paediatric formulations. Unless such an approach is taken, generic drug companies cannot continue to produce new innovative products for developing countries, she warns.
Will & Deni McIntyre/Science Photo Library
Urgent action needed to defuse HIV treatment timebomb
Antiretroviral availability has remained low despite G8 targets
UNITAID is talking to major stakeholders—from patent holders to potential licensees—and hopes to have the patent pool established by the end of the year. “Everyone recognises that something needs to be done”, but although some parties are very positive others are more hesitant, says ’t Hoen. However, “it’s an unbelievable opportunity to get something right and will become increasingly important for the future”, she says. The Treatment Timebomb concludes with a call for political activism, but noting that all parties must be involved and pharmaceutical companies need not be cast as the enemy. What is needed most now is political leadership, says Veronica Oakeshott, the parliamentary group´s policy advisor. Montaner points out that at the 2005 G8, the UK played a key part in developing the universal access goal for ARVs. But, current G8 head Stephen Harper, the Canadian Prime Minister, is not prioritising HIV at the summit. “People of the G8 countries need to know that we are walking away from promises”, says Montaner. He is urging the UK government to use the report to demand that action on HIV be put at the top of the agenda for the 2010 G8 summit. “The consequences of not doing so will be devastating for us and for generations to come.”
For more information on The Treatment Timebomb report see http://www.aidsportal.org/ repos/APPGTimebomb091.pdf
Kelly Morris 593
1 year before the G8 target of universal access to antiretrovirals (ARVs), only a third of those in need are receiving medication. With the HIV pandemic continuing to spread dramatically, an inquiry by the UK all-party parliamentary group on AIDS “shows that we are sitting on a treatment timebomb”. Action is needed now, to avert crisis later, says the report, which predicts that over 50 million people worldwide could need ARVs by 2030. The International AIDS Society has applauded The Treatment Timebomb report. Society president Julio Montaner explains that suppression of viral load reduces transmission rates of both HIV and tuberculosis to the wider community. “The more you treat, the more lives are saved, the more families are protected, the more people can go back to work”, he says. But, universal access to ARVs “is not just the humanitarian, ethical, or costeffective thing to do”, he continues. “It is cost-averting”, and vital especially in times of fiscal crisis. Most importantly, he stresses, universal ARV coverage is an essential part of the solution to control and reduce the spread of HIV, which is a millenium development goal for 2015. The UK International Development Minister Mike Foster told TLID that “we must think ahead when it comes to HIV treatment. The number of people needing treatment, and more complex and expensive treatments, will continue to rise. The price of those treatments is an issue now, and will only grow bigger in the future.” The report notes that, in some countries, access to therapies to prevent vertical transmission is particularly poor, whereas treatment for adults and children is often started late on the basis of symptoms, because of the lack of CD4 count testing. Revised WHO guidelines due to be released later this year are expected to raise the CD4 count at which to begin treatment, which will mean more people will be www.thelancet.com/infection Vol 9 October 2009
immediately eligible for ARVs. Effective treatment will increase lifespan, and thus more people will need drugs for longer, but effective treatment is a key part of the strategy to eliminate HIV, says Montaner. “We need to get policy makers to understand this”, he urges. The UK all-party parliamentary group is calling for immediate action and long-term plans by countries and donors, including secure financial commitments to ensure continued ARV supplies and bulk ordering to reduce costs. Stakeholders need to work together to decide the optimum balance of spending between treatment and other prevention efforts, the report recommends. Cheap CD4 tests are also urgently needed to guide treatment. Poor adherence, interrupted drug supplies, and counterfeit drugs increase the likelihood of resistance, which necessitates newer ARV regimens. Notably, adherence and cost-savings can be substantially improved by use of generic fixed-dose combinations. However, the World Trade Organization is tightening rules on patenting and so reducing new generic drug production. Foster points out that the UK Department for International Development is working with manufacturers to lower the price of drugs, and supports the initiative by UNITAID to develop an ARV patent pool. In principle, companies will pool their patents, which are then available for license—eg, to generic manufacturers—in return for a royalty payment. Voluntary licensing schemes already exist but via individual companies, whereas the UNITAID patent pool would be a “one stop shop”. Ellen ’t Hoen, UNITAID, Geneva, Switzerland advises that the patent pool will overcome many obstacles, especially to rapidly produce new fixed-dose combinations and urgently needed paediatric formulations. Unless such an approach is taken, generic drug companies cannot continue to produce new innovative products for developing countries, she warns.
Will & Deni McIntyre/Science Photo Library
Urgent action needed to defuse HIV treatment timebomb
Antiretroviral availability has remained low despite G8 targets
UNITAID is talking to major stakeholders—from patent holders to potential licensees—and hopes to have the patent pool established by the end of the year. “Everyone recognises that something needs to be done”, but although some parties are very positive others are more hesitant, says ’t Hoen. However, “it’s an unbelievable opportunity to get something right and will become increasingly important for the future”, she says. The Treatment Timebomb concludes with a call for political activism, but noting that all parties must be involved and pharmaceutical companies need not be cast as the enemy. What is needed most now is political leadership, says Veronica Oakeshott, the parliamentary group´s policy advisor. Montaner points out that at the 2005 G8, the UK played a key part in developing the universal access goal for ARVs. But, current G8 head Stephen Harper, the Canadian Prime Minister, is not prioritising HIV at the summit. “People of the G8 countries need to know that we are walking away from promises”, says Montaner. He is urging the UK government to use the report to demand that action on HIV be put at the top of the agenda for the 2010 G8 summit. “The consequences of not doing so will be devastating for us and for generations to come.”
For more information on The Treatment Timebomb report see http://www.aidsportal.org/ repos/APPGTimebomb091.pdf
Kelly Morris 593