A significant step forward in AIDS fight
Stabroek News
October 8, 2001

A major breakthrough is how one would have to describe the announcement on Friday by Health Minister Dr Leslie Ramsammy that by next month low cost anti-HIV drugs will be available for all those afflicted by the virus that causes the deadly AIDS disease.

According to Dr Ramsammy, these drugs will cost between US$250 and US$350 per annum per patient as compared with the previously quoted commercial price of between US$10,000 and US$12,000 for a patient each year.

On the signature of an agreement for the supply of drugs at these prices, a major step will be taken towards reining in the disease. At the prices quoted by Dr Ramsammy, those carrying the virus would be able to buy the drugs for between $138 to $182 per day compared to the staggering $5,205 at the commercial price. There is also the prospect that the government may be willing to foot the bill for some patients. It has already embarked on providing medication to slash the mother-to-child transmission of the HIV virus.

With an estimated three to five percent of the local population infected with the HIV virus - many without even knowing - an aggressive education, prevention and treatment campaign is required. For the first half of last year there were 577 cases of HIV infection reported to the Genito-Urinary Medicine clinic and the national figure is believed to be significantly higher. Approximately only 20% of those who are infected know this and not being aware of their condition, a severe threat is posed to the persons they have sexual relations with.

It is so far unclear where the drugs will come from but the government has been in negotiation with the Indian firm Cipla and there are suggestions that Brazil's thriving generic HIV drugs industry will also be tapped.

Up to now, except for those who could afford the HIV drugs, treatment has been limited to medicating the opportunistic infections that attack the ravaged immune systems of patients. The drugs that will become available from next month offer a chance for HIV patients to live a prolonged and more normal life.

There are several classes of HIV drugs: nucleoside analogues that inhibit the enzyme reverse transcriptase (AZT is the best known of these and has worked well in restricting mother-to-child transmissions), non-nucleoside reverse transcriptase inhibitors and protease inhibitors. Using these in combination therapy has led to steep declines in AIDS deaths and the virus can be reduced to undetectable levels even though it continues to lurk in various parts of the body hence the person is never fully cured of the disease.

The arrival of the drugs will usher in a new and important phase of the AIDS fight which will require intensive work and there will be setbacks. These drugs have serious side effects, do not work for all patients and the effectiveness of individual drugs wears off necessitating substitutions in the cocktail. More importantly, these drugs have to be ingested in accordance with a rigid schedule. It can be very disruptive as some tablets have to be taken on a full stomach and others on an empty one. Failure to adhere to this schedule could lead to dangerous levels of the virus prevailing and aggressive mutation of the HIV strain with the concomitant growth of resistance to the drugs being used. HIV is a virulently mutating virus which can create mind-boggling numbers of different strains. It is one of the attributes of the HIV virus that has thwarted the development of a vaccine.

So in conjunction with the supply of drugs an even more intensive education programme has to be nurtured here so that patients can appreciate the importance of taking these drugs in the prescribed manner.

Brazil's success story has been underpinned by massive expenditure and an innovative educational programme which also encompasses schoolchildren. By spending US$300M on free treatment each year, Brazil has managed to slash its AIDS death rate by 60%. It has also not been shy about sex education. In high schools in Sao Paulo, teenage students practise putting condoms on clay models as part of their learning about the disease.

Our prevention and education campaigns will have to see significant new investment if the full benefits of the promised drug supply are to be realised.