Drugs Don't Work for Many Indian AIDS Patients

India's National AIDS Control Organization has decided its five-year HIV strategy will include increasing access to free first-line HIV drugs, according to Dr. Po-Lin Chan, a World Health Organization advisor to the program. However, NACO has decided it cannot afford to introduce newer second-line drugs for distribution to AIDS patients whose virus is resistant to first-line therapies.

India introduced free antiretroviral drug (ARV) treatment in 2004. About 500,000 patients need ARVs, but just 35,000 patients (7 percent) receive free treatment through NACO. By 2012, NACO aims to have 300,000 patients on ARVs.

For the most adherent patients, NACO expects ARV treatment failure of 2-3 percent per year, or 1,000 patients at current treatment rates. However, critics say poor local medical advice and clinic supply interruptions mean that many more patients will develop resistance - problems NACO is working to address.

"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."

Second-line ARVs cost 4,000-8,500 rupees ($85-180 US) for a month's supply, compared with 450 rupees ($10 US) for first-line drugs.

"I think prices can be considerably lower than they are today," said Indrani Gupta, head the New Delhi Institute of Economic Growth's unit for health policy research. "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."

Brazil is the only resource-poor country that offers free second-line drugs to its citizens, said Chan. It also spends much more on treatment, though its HIV caseload is only about one-tenth of India's. India spends much more on HIV prevention than treatment, though its generic drug manufacturing sector provides most of the world's cheap ARVs.

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