Drugs don’t work for many India AIDS patients
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The drugs Shyamal Kumar Dey takes to fight AIDS don’t work anymore.
The 38-year-old father of one has been swallowing antiretroviral pills for the last five years, enough time for the HIV virus to mutate into a drug-resistant form.
Since then, the virus has found a new lease on life in his body, sapping both his immune system and his hopes for the future.
Ditching his current pills and switching to so-called “second-line” drugs would almost certainly bring Dey’s disease back under control.
Unfortunately, these drugs are so expensive that even the Indian government, which pays for Dey’s now useless first-line drugs, says it cannot afford to include second-line drugs in its national program.
A month’s supply costs between 4,000 and 8,500 rupees ($85-$180), compared to the 450 rupees cost for first-line drugs.
Dey’s job as a counselor to other HIV sufferers pays about 4,000 rupees a month, barely enough to cover the rent, feed his family and school his 6-year-old son.
Although India is one of the world’s largest manufacturers of generic antiretrovirals, Dey has no idea how to get his hands on second-line drugs that could prolong and improve his life.
“I don’t know what’s going to happen,” Dey said. “Whatever God will do I must accept.”
AIDS researchers will debate the plight of people like Dey and other issues at the 16th International AIDS Conference, the world’s biggest conference about the disease, in Toronto next week.
SECOND-LINE MUST WAIT
One in every seven HIV-positive people lives in India, home to an estimated 5.7 million people with the virus, according to UNAIDS, the United Nations’ HIV and AIDS prevention agency.
A good half a million of those are likely to have immune systems so weak that they need antiretroviral drugs.
Of these, the government reaches only 35,000 people—or 7 percent—with free first-line drugs through its National AIDS Control Organisation (NACO).
Many people, particularly in rural India, simply do not know they have the virus and die without treatment.
India is finalizing this month the next five years of its AIDS control strategy and has decided it is more important to get more needy people taking first-line drugs than to introduce second-line medication, according to the World Health Organisation’s Dr Po-Lin Chan, an adviser to the program.
The country, which began its free antiretroviral program in 2004, aims to get 300,000 people on first-line drugs by 2012.
“We have to ask ourselves what the priorities are,” said Chan. “Probably 90 percent of patients will need first-line drugs for quite some time, so let’s keep them on them as long as possible.”
But critics say problems in the first-line drug delivery systems are causing resistance to become more widespread.
PROBLEMS AHEAD
Immunity to first-line drugs develops particularly quickly—perhaps within a year or two—if AIDS patients repeatedly fail to gulp down their two or three pills a day.
Even among the most diligent takers of pills, NACO expects 2 to 3 percent of these patients to develop immunity annually—at least 1,000 HIV patients every year at current treatment volumes.
But many other patients are developing resistance because they have been poorly advised or because clinics have run out of drugs—problems NACO is working hard to fix.
A forthcoming study by the YRG Centre for AIDS Research concludes that between 15 and 20 percent of antiretroviral patients in the south Indian city of Chennai have a strain of HIV immune to first-line drugs.
Second-line drugs are more expensive than first-line medications because they are made using a more complex synthesis process out of costlier raw materials and are given in higher doses.
Economists say the gap would narrow if governments around the world moved jointly to include the drugs in their programs.
“I think prices can be considerably lower than they are today,” said Indrani Gupta, head of the health policy research unit at New Delhi’s Institute of Economic Growth.
“But there isn’t yet a critical mass of demand for second-line drugs so there’s no incentive for manufacturers to bring down prices,” he added.
A DIFFERENT APPROACH
For the time being, Brazil remains the only “resource-strapped” country to supply free second-line drugs to its citizens, says the WHO’s Chan.
It spends considerably more on its HIV/AIDS program than India despite having roughly a tenth of the caseload, with most of its budget spent on treatment.
By contrast, India spends the bulk of its money—a total of $200 million for 2006 to 2007—on AIDS prevention programs rather than treatment. But not everyone believes it has struck the right balance.
So long as few people have access to second-line drugs, there is a greater risk of first-line-resistant strains of HIV becoming more widespread.
But even more fundamentally, India needs to identify and treat HIV-positive people to prevent the virus spreading.
Loon Gangte of the Delhi Network of Positive People advocacy group, said a good treatment program including a second-line treatment option can help encourage suspected HIV sufferers to get themselves diagnosed and take precautions.
“Prevention starts with positive people,” says Gangte, who is himself HIV positive.
“Two people without HIV can have sex a thousand times in one night and they’re not going to get HIV. But if I go tonight and have sex with one man there is a risk of passing on the infection.”
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