Cost of HIV treatment

Drug companies market their antiretroviral drugs at different prices depending the type of drug and the target consumers. The cost of HIV treatment for first-line therapy has generally been lowest due to the availability of generic drugs designed for such treatment. If patients develop complications or resistance to first line therapy drugs, they may need to proceed to second-line or third-line therapy to successfully limit the HIV infection. First-line treatment The first-line treatment is generally given to patients as an initial antiretroviral therapy and is the cheapest of the stages of treatments. Low-income countries There have been considerable reductions in the prices of first-line treatments over several years in low-income countries, which may be due to the increased market competition among producers driving them to bring generic drug prices down. In 2014, PEPFAR calculated the estimated mean total cost per patient-year of treatment in the programs, including financial and in-kind contributions from all sources (including partner governments and other bilateral and multilateral donors), is $757 and that in low-income and lower middle-income countries, the mean cost per patient year of treatment when taking into account all sources of support is $645. PEPFAR calculated that their share of the cost for first-line treatment was $286 per patient per year, a considerable price reduction from its 2003 price of $1100 per patient per year. Switching to either of the therapies often involve a leap in prices; moving from first-line to second-line treatment may mean a nearly threefold increase in cost, and moving from second-line to third-line treatment may mean a nearly seven-fold increase in cost (eighteen-fold increase from first-line). Low-income countries According to PEPFAR in 2014, the average cost of second-line treatment was $657 versus the average cost for first-line treatment of $286. ==High prices of HIV treatment==

The high cost of certain antiretroviral drugs, especially those of middle- and high-income countries, has been a pressing issue which stemmed from a variety of factors and may have adverse and unintended consequences. Despite government and activist efforts to limit the price of HIV drugs, they have still often remained at unaffordable prices due to reasons such as patent barriers on antiretroviral drugs and slow regulatory approval. However, because MPP drug licenses were often prohibited from violating active patents of various countries, they were unable to provide the cheaper generic drugs and negotiated licenses to such nations. Second- and third-line antiretroviral drugs have been even more susceptible to increased prices from patented drugs due to a lack of generic drug providers. For example, the biopharmaceutical company AbbVie charged $740 per patient per year for second-line LPV/r in middle- and high-income countries and $231 per patient per year in low-income countries (2016). Delayed processes in patent approval may also be a barrier to lower HIV treatment costs. The detection for HIV resistance can also be difficult and expensive as well, rendering lower-middle income countries unable to have access to various resistance tests and identifying resistant patients for treatment switches. HIV patients who have already developed resistance to first-line treatment are often barred from overcoming their resistance due to the difficulty in obtaining second- or third-line treatments, which can be several times more expensive than first-line treatment. In individuals infected with HIV, they may also have a weakened immune system, rendering them more susceptible to opportunistic infections such as invasive cervical cancer, Kaposi's sarcoma, and tuberculosis. The high price of antiretroviral drugs may act as a barrier to HIV treatment, thereby increasing the likelihood of developing an opportunistic infection. On September 14, 1989, members of ACT UP protested at the New York Stock Exchange over the Burroughs Wellcome's setting a price of US$10,000 per year for AZT, which was the only effective treatment for HIV discovered and was unaffordable to many HIV positive persons. Several days later in response to the protest the company lowered the price of AZT to $6,400 per patient per year, a 20% reduction. In response, 39 pharmaceutical companies filed a class action lawsuit. In 2000, the Treatment Action Campaign of the International AIDS Conference in Durban prioritized increasing access to antiretroviral drugs and created the Global March for Treatment. This great price difference demonstrated the possibility of considerably more affordable antiretroviral drug costs to the public, prompting greater widespread activism. In 2003, HIV/AIDS was officially declared a global health emergency by the WHO, and for the next several years, with the combined effort and funding from organizations such as national governments, the Global Fund, and PEPFAR, the cost of HIV treatment was able to decline and accessibility to generic drug brands increased, especially in developing nations. In 2010, the Medicines Patent Pool (MPP) was founded for the purpose of negotiating with pharmaceutical companies to reduce drug prices for treatment of HIV as well as other diseases, allowing countries who are part of the agreement to further offer reduced drug prices to consumers. ==References==