By Greg Perry, Executive Director, Medicines Patent Pool
The international community has come a long way since the first AIDS conference in 1985. Although we are still waiting for an effective HIV vaccine and a functional cure, ART innovation and scale-up has made a significant difference in changing the landscape of the global response to HIV/AIDS.
Over the past 31 years, 29 new chemical entities have been approved for the treatment of HIV. The discovery of HAART, unveiled at the 11th annual IAC in 1996, was a game changer in moving HIV/AIDS from a death sentence to a chronic condition. In 2001, triple fixed-dose combinations brought together various ARVs into single tablet regimens. Now, as we enter the fourth decade of HIV, we can once again see the promise of new medicines that will help improve today’s regimens, with drugs that appear to have higher barriers to resistance and better safety profiles. Over the past three years, regulators have approved four new ARVs and at least one more ARV is in late stage clinical development.
We must ensure that these newer medicines become available at affordable prices in developing countries as fast as possible. Historically, it has taken an average of seven to nine years for generic versions of new HIV treatment to reach low-income countries after introduction in industrialised nations. Our organisation, the Medicines Patent Pool (MPP), partners with pharmaceutical companies to shorten this timeline. The MPP enters into licensing agreements that now allow generic manufacturers to develop the latest treatments shortly after their approval in the US and Europe. For example, our recent licence on dolutegravir, a promising new integrase inhibitor, should enable generics to enter the market within two to three years from originator approval.
In the field of paediatric HIV, not enough has been done to ensure that children have adequate care. Although the world has made significant progress in scaling-up treatment for adults, only a quarter of the 3.3 million children living with HIV in the developing world have access to treatment. In partnership with UNITAID and the Drugs for Neglected Diseases initiative (DNDi), the MPP is working with various stakeholders to contribute to overcoming this gap through the development of more child-friendly formulations of WHO recommended treatments.
Every two years, the International AIDS Conference provides an opportunity to take stock of our progress and discuss new developments to improve our collective response to AIDS. As we approach the 2014 IAC, I think there is good reason to be optimistic about tomorrow’s treatment options, but only if we work in concert with other organisations to break down barriers to access and availability in countries hardest hit by the epidemic.
Just imagine a future in which HIV treatment side effects are minimal and rarely result in treatment discontinuation; a future in which cost is no longer a factor in ensuring the most suitable treatment and new ARVs become available to people in the poorest countries shortly after they are launched in the richest ones. In this scenario, children would take a simple and effective medicine once-a-day that is appropriate for their age and weight.
The history of the last 30 years suggests these are reasonable predictions. With continued strong leadership and political will, active community mobilization and suitable partnerships with clear objectives, we can develop and deliver the right HIV treatment at the right price to those most in need. Exciting new medicines are on the horizon that may change the way we treat HIV, reduce side effects and improve treatment outcomes at a more affordable cost. That future is clearly within reach, but it will require a re-doubling of efforts from all stakeholders.