Treatment and resistance
Around 37 million people around the world are infected with HIV, according to the United Nations AIDS agency UNAIDS. Just over half of them - about 19.5 million patients - get antiretroviral therapy medicines to keep their disease in check.
That represents remarkable progress in the past 20 years, driven by the availability of a first wave of cheap generic drugs from Indian companies. But rising levels of drug resistance are now a growing concern, while low prices have cut the incentive for investment in generic drugmaking capacity.
In six out of 11 countries surveyed recently in Africa, Asia and Latin America, researchers found that more than 10 percent of HIV patients starting antiretroviral drugs had a strain of HIV resistant to the most widelyused medicines.
Once the 10 percent threshold is reached, best practice calls for switching to different drug regimens.
Dolutegravir is already being used on a limited basis as a single drug in Kenya, Nigeria, and Uganda.
The drug was originally developed by ViiV Healthcare, the HIV business majorityowned by GlaxoSmithKline. ViiV has offered licensing deals to generic companies to sell low-cost versions of the medicine in poor countries.
Clinical trials have shown that treatment regimens including dolutegravir work faster, have fewer side effects and demonstrate greater potency against drug resistance than standard HIV drugs used in Africa and other poor countries. The TLD combination pill developed by Mylan and Aurobindo has already received tentative approval from the U.S. Food and Drug Administration under the President’s Emergency Plan for AIDS Relief programme.
In Western markets, makers of patented AIDS drugs, such as GSK and arch-rival Gilead Sciences, notch up billions of dollars of highly profitable sales each year.
But the picture is very different for low-price generic companies in India, which have very low margins.
“The market is always on the edge where these guys don’t make enough money to stay in the business,” said Gates.
With the HIV-positive population still growing - there were an estimated 1.8 million new cases of infection in 2016 - the number of patients needing treatment is steadily increasing. –