As the International AIDS Society Conference gets underway in Rome, several pharmaceutical companies stand accused of abandoning HIV drug discount programmes in middle-income countries.

The claim is made by Medicins Sans Frontieres (MSF – Doctors Without Borders) which has analysed the prices of 23 antiretrovirals with information provided by 19 manufacturers. It notes that Johnson & Johnson's Tibotec unit exclude all countries classified as middle-income from their price reductions, while Abbott Laboratories gives no discounts to low-income and lower middle-income countries for one of its drugs.

MSF's report goes on to state that ViiV, the joint venture between Pfizer and GlaxoSmithKline,  no longer offers reduced prices to middle-income countries, "even when programmes are fully funded by the Global Fund to fight AIDS, TB and malaria or the US government’s PEPFAR programme". It also claims that Merck & Co has reversed a previous policy and will no longer issue price discounts for 49 middle-income countries for Isentress (raltegravir).

This move leaves out countries with large numbers of people living with HIV/AIDS, such as India, Indonesia, Thailand, Vietnam, Ukraine, Colombia and Brazil, MSF argues. The latter is paying $5,870 per patient per year (ppy) for Isentress in least-developed countries, while Merck charges $675 ppy for the drug, which is already four times the price of the recommended triple first-line combination, ie TDF/3TC/EFV.

Discount programmes not working

“Drug company discount programmes have proven not to be a long-term solution,” said Janice Lee, HIV/AIDS pharmacist at MSF’s Campaign for Access to Essential Medicines. “When patents get in the way and drug companies refuse to cut prices, governments are going to have to start overriding patents so that they can afford to keep their HIV-positive people alive.”

However, the MSF analysis says there is some good news to report. Thanks to continued generic competition, Gilead Science's "critical drug" Viread (tenofovir) now costs $76 ppy which is cheaper than the price of AZT (zidovudine) which costs $88 ppy. This means "it is becoming more affordable for countries to shift to using World Health Organisation-recommended improved combinations with tenofovir and move away from the drug stavudine (d4T), which has significant long-term side effects".

The price of a one-pill-once-a-day combination that contains tenofovir has come down by 70% since the WHO recommended people move to less-toxic treatment five years ago, from $613 to $173 ppy. “We’re seeing drug prices continue to decline when patents do not form a barrier to generic production,” added Ms Lee, saying that "these reductions increase the feasibility of reaching the new United Nations goal of getting 15 million people on treatment by 2015".

B-MS, Boehringer in patent pool talks

The report comes a week after it was announced that Gilead Sciences has signed up to the Medicines Patent Pool to improve access to HIV treatments in poor countries. The MPP has just revealed that it has begun negotiations with Boehringer Ingelheim and Bristol-Myers Squibb regarding an agreement.

Ellen ‘t Hoen, executive director of the MPP, said that of "all pharmaceutical companies with HIV medicines patents, only three are currently not in negotiation with the Pool. We call on J&J, Merck, and Abbott to follow the lead of their colleagues and enter into negotiations with us".