Differential treatment: restricted access to newer antiretrovirals.

• Author: Zaidi, Sarah

The discovery of antiretroviral (ARV) treatment for people living with HIV (PLHIV) is one of the best success stories of medical research in recent years. It has changed the way in which HIV is viewed--from that of a death sentence to a chronic illness. However, lifelong treatment requires constant access to newer drug regimens, as an HIV-infected person either develops serious side effects, or the virus becomes resistant to the drugs. While patients in developed countries have treatment options, the same cannot be claimed for those in developing countries. With more than twenty approved antiretroviral drugs, the global HIV drug market is estimated to approach $16 billion by 2016. Yet, not all ARVs, especially newer and more potent treatments, are licensed or available in every country, particularly in the global South. Why is there such a gap in access to treatment between industrialized and developing countries? Why are newer, more potent, less toxic ARVs not available to PLHIV in the global South? How can this growing disconnect between treatment options be altered?

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Today there are 33.3 million HIV-infected people worldwide, 95 per cent of whom live in developing countries, and approximately 2.7 million new infections a year. Most of these people will need to be treated if they are to live healthy and productive lives. It is estimated that by 2030, fifty-five million people will need treatment. At the end of 2009, UNAIDS (Joint United Nations Programme on HIV/AIDS) estimated that five out of fourteen million people who needed treatment were on ARVs. (1) The treatment options that were available to HIV-infected people accessing ARVs through state-based healthcare systems depended on the cost of medication. These drugs saved lives but came with serious side effects. If a patient was unfortunate enough to experience treatment failure--often undiagnosed due to expensive testing that was maladaptive for developing countries--or serious side effects, they were left with few or no alternatives.

The most commonly used treatment in developing countries contains the drug Stavudine (d4T). It causes serious long-term, irreversible side effects and was recommended to be phased out by the 2009 revised HIV treatment guidelines of the World Health Organization. Although Stavudine is no longer used in developed countries, a majority of people in developing countries continue to receive some combination of treatment containing it...