Johannesburg - Lack of access to new drugs is threatening the survival of AIDS patients who have already begun treatment, Medecins sans Frontieres (Doctors without Borders, MSF) said Monday. In a report released at the 5th International Aids Society conference in Cape Town, the medical aid organization noted that, of the 10 million people in developing countries needing AIDS drugs, only around 3 million were currently on treatment.
And of the 3 million on treatment, many were again staring death in the face after developing drug resistance and being cut off from new drugs available to patients in the West.
After a sustained period on the same drug regimen HIV patients often develop resistance to the treatment. In Europe and the United States they are routinely switched to second-line or third-line treatment, but these drugs are not yet widely available in the developing world because of their high cost.
"In some countries, switching a patient from first- to second-line regimen increases the cost of treatment as much as seventeen-fold," MSF said.
In Khayelitsha township outside Cape Town, where MSF pioneered South Africa's first antiretroviral (ARV) treatment programme in 2001, 16 per cent of patients had developed resistance to first-line drugs within five years, the report said.
MSF highlighted the case of a mother of two from the township who began using ARVs in 2003 and had since developed resistance to both first- and second-line treatment.
The woman's life was in danger because "there is currently no third-line treatment available in South Africa," the country with the largest number of HIV-positive people worldwide, the report said.
While first-line drugs are now widely available in generic form after countries like India and Thailand began making their own, many second-line and third-drugs are still protected by patents, putting them beyond the reach of developing countries.
MSF called on the developing countries to consider their own public health needs before granting the patents. Where the patents had already been granted, countries could override them by, for example, issuing compulsory licenses for the manufacture of generics, as Thailand did with first-line drugs, MSF said.
To avoid such a scenario, pharmaceutical companies should to put their AIDS drug patents in a "patent pool" that international drug financing agency UNITAID is creating to allow poor countries access critical drugs at affordable prices, MSF said.
To avoid patients defaulting on their treatment and minimize the development of ARV resistance in the first place, MSF also recommended that governments roll out improved, less toxic first-line drugs.
Many developing countries are still providing stavudine as one of three combination AIDS drugs even though the drug has severe side effects and the World Health Organization recommends an alternative, called tenovir.
Drug resistance could also be reduced through better diagnosis and quicker intervention where treatment was not working, MSF said.
For example, the most common test to determine how HIV patients are faring is currently the CD4 count - a measure of the patient's immune system - but testing the patient's viral load, or the amount of the virus in the blood is a far better measure of treatment failure, according to MSF.
"We need to provide the most robust first-line treatment possible, to detect treatment failure through monitoring HIV levels in the body before patients show symptoms, and to provide access to affordable second- and third-line treatment combinations," Dr Eric Goemare, MSF medical co-ordinator in South Africa, said.
"None of this is happening now, which means that thousands of patients are back on AIDS death row," he said.
At the same time, MSF sounded the alarm over the around 7 million HIV patients in the developing world still waiting to be enrolled on first-line treatment.
Clinics in some African countries are suspending the enrolment of new HIV patients on treatment because of funding shortfalls. As donor governments review their aid spending, organizations such as the Global Fund to fight AIDS, tuberculosis and malaria, that fund treatment, face shortfalls of billions of dollars, MSF said.
