The price of first- and second-line antiretrovirals to treat HIV is falling because of increased generic competition, but newer drugs "continue to be priced astronomically high".

That is one of the claims of a report released by Medecins Sans Frontieres at the International AIDS Society conference in Kuala Lumpur. It notes that the ‘best possible’ price of a World Health Organisation-recommended one-pill-a-day first-line combination (tenofovir/lamivudine/efavirenz) has fallen 19% since last year (from $172 to $139 per person per year), with some countries able to achieve even lower prices in large volume orders.

Also, as generic competitors have emerged, the prices of two key medicines used in second-line treatment - atazanavir/ritonavir and lopinavir/ritonavir - have each fallen by 28% over the last year, with the most affordable second-line combo - (zidovudine/lamivudine + atazanavir/ritonavir) now priced at $303 per year. This represents a 75% drop in the price of second-line treatment since 2006.

But for newer patent-protected HIV medicines, including integrase inhibitors, the best possible price of a possible salvage regimen for people who have failed second-line treatment (raltegravir + etravirine + darunavir + ritonavir) is $2,006 per year in the poorest countries, nearly 15 times the price of first-line treatment, MSF says. The report states that countries that do not have access to these lowest available prices are paying many times more. For example, Thailand and Jamaica pay $4,760 and $6,570 respectively for darunavir alone and Armenia pays $13,213 just for raltegravir.

Jennifer Cohn, medical director at MSF’s Access Campaign, said "we need to watch carefully as newer, better medicines reach the market in coming years, as these are the drugs that we’ll quickly be needing to roll out.  The price question is far from resolved".

Uptake of ARV therapy leaps

The MSF analysis came just after a report was published by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the WHO and UNICEF which shows "a huge acceleration" in the roll out and uptake of ARV therapy. Some  9.7 million people living with HIV were accessing treatment last year compared to just over 8.1 million in 2011.

The WHO has issued new recommendations that people living with HIV should start on ARVs much earlier, and under this new guidance some 26 million people will now be eligible for these therapies, an additional 9.2 million from the previous 2010 guidance.

The challenge remains identifying who is infected and at the moment doctors refer to a patient’s CD4 count to determine when to begin HIV treatment. However, this is a complicated and expensive process and particularly problematic in poor countries.

Zyomyx, Mylan link up for cheap CD4 test

Against this background, a US diagnostics firm, Zyomyx, has made a point-of-care CD4 T-cell count test which is in late-stage development. The test is portable and disposable and provides results in just 10 minutes and the company says it has proven to be equivalent in accuracy to flow cytometry, the current gold standard in CD4 count testing.

Now Mylan has signed up to distribute the test in the developing world and has also made a strategic equity investment ($6 million) in privately-owned Zyomyx, which also gets funding from the Bill & Melinda Gates Foundation.