Four ways to beat HIV/AIDS

In the fight against HIV/AIDS, some stories illuminate the long road to global eradication more than others. In 2009, I heard one such story in Tanzania.

I was visiting a remote village when I spoke to a woman who knew that she was HIV-positive. She told me that the established health guidelines at the time indicated that she could not receive treatment until her count of CD4 T-helper cells, a type of white blood cell used by the immune system, had dropped below a certain threshold.

After walking several miles to get her count checked, she arrived at the clinic only to find its testing machine broken. The machine was still inoperative the second time she made the long journey. Only months later, after her third trip to the clinic on foot, did she receive her cell count: her levels were far below the necessary threshold. Her treatment should have begun months before.

Since HIV/AIDS was first identified in 1984, it has killed more than 35 million people. Although the number of AIDSrelated deaths has fallen by almost half since peaking in 2005, there are still far too many people dying from this preventable condition. In 2016 alone, one million people around the world died from HIV-related causes, while 1.8 million more became infected. Contrary to popular myth, we have not turned the corner on AIDS – not by a long shot.

World AIDS Day, on December 1, was an occasion to honour the millions of victims, and to recommit to ending this devastating disease. According to UNAIDS, just 54% of HIV-positive adults, and only 43% of HIV-positive children, are currently receiving the antiretroviral therapies that save lives and prevent new infections. With so many untreated patients, the virus will continue to spread.

As CEO of a global pharmaceutical company, I’m proud of the work we have done to fight HIV/AIDS around the world. Today, more than eight million people – nearly half of all patients receiving treatment for HIV in developing countries – depend on the antiretroviral treatments that we produce.

But for those of us on the front lines of this struggle, our work is far from over. The pharmaceutical industry has a responsibility to expand access to testing and treatment, and to help stop the spread of HIV once and for all. Fulfilling four key commitments will make this goal achievable.

For starters, pharmaceutical companies should do more to increase the availability of low-cost, generic medicines. My company, Mylan, introduced the first generic once-daily pill for developing countries in 2009, and we have continually reduced its price to make it more accessible to more people. With this treatment alone, Mylan and other generic manufacturers save the US government, international donors, and national health programmes more than $4.5 bln a year.

Still, treatment options could be expanded further. In September, Mylan announced a collaboration with UNAIDS, the Bill and Melinda Gates Foundation, the Clinton Health Access Initiative, and other partners to provide the nextgeneration single-pill HIV regimen to patients in more than 90 low- and middle-income countries for less than $75 per year. These drugs are widely used in high-income countries because they produce fewer side effects. Affordability initiatives like this one should be replicated.

Next, drug makers must continue investing in capacity and supply-chain reliability. Since 2005, the number of people on antiretroviral therapies worldwide has grown by a factor of ten, to 21 million. But roughly twice as many people are currently infected with HIV. Over the last decade, Mylan has invested more than $250 mln in expanding production capacity, and we now produce four billion tablets and capsules each year. But further investments are needed if we are to provide access to the other 21 million people still not on treatment.

A third urgently needed commitment is to increase support for research that accelerates the development of new innovations in effective and efficient treatment delivery. For example, Mylan provides study medications to research trials, like the MaxART trial in Swaziland, which demonstrated that providing treatment to all HIV-positive people is the best way to slow the disease’s spread. We also supported the Kirby Institute’s ENCORE1 trial, to develop a reduced-dose version of the most commonly used HIV treatment regimen. And we are currently working with the US Agency for International Development as part of a partnership called OPTIMIZE, which aims to accelerate access to new therapies.

We do not support trials like these because we hope to gain any marketable intellectual property – we won’t. Rather, we support them because it is the right way to advance science and improve treatment.

Finally, real gains in the fight against HIV/AIDS will require drug makers to account for the limitations of healthcare systems and distribution networks in the developing countries they serve.

Antiretroviral therapies for children are a good example of these challenges. Drugs for young people produced in the West are often liquids that require refrigeration. But developing countries often have limited cold-storage capacities or an inability to transport liquid in bulk. That’s why Mylan has developed heat-stable, taste-masked, dispersible tablets that can easily be incorporated into food. Our scientists are now working on the next-generation formula, which comes in the equivalent of a sugar packet that even newborns can take. More innovations like these will be needed to solve the country-specific issues that patients face.

The global health community has made remarkable progress in turning the tide on HIV/AIDS, introducing new products and advocating for earlier treatment. But when I think back to the woman I met in Tanzania, I am reminded of how much work remains to be done. Makers of generic medicines have an important role to play in this fight, and we will not stop working until treatment is available to every patient in the world who needs it.