HIV/AIDS drugs

Merck Co., Inc. 2004. Merck Co., Inc. Grants License for HIV/AIDS Drug Efavirenz to South African... 

Thomas, J. R. 2001. HIV/AIDS Drugs, Patents, and the TRIPS Agreement Issues and Options. Congressional Research Service. 

Raltegravir, or Isentress (1), is the first FDA-approved inhibitor of HIV integrase. HIV/AIDS drugs are categorized according to their mode of action as nucleoside and nucleotide reverse transcriptase inhibitors [NRTIs, e.g., tenofovir (2)], nonnucleotide reverse transcriptase inhibitors [NNRTIs, e.g., efavirenz (3)] protease inhibitors [Pis, e.g., ritonavir (4)], fusion inhibitors [e.g., enfuvirtide (5)], entry inhibitors... 

The debate about compulsory licenses for patented products occurred in the context of access to HIV/AIDs drugs in Africa. At issue was the effect of patent rights on the accessibility and affordability of pharmaceutical products and vaccines in developing nations. Similar concerns around access and cost are likely to develop with biopharmaceuticals and other innovations resulting from research in health biotechnology. 

E-factor of an API synthesis reduces costs. With a continued growth of volume demand, improved chemistry and competition horn multiple suppliers, the cost of raw materials and APIs can decrease over time. For example, the cost of the API for the HIV/AIDS drug efavirenz at laimch hy the originator company (Dupont Pharmaceuticals) in 1998 was about l,600/kg at a first-year demand of about 150 tons (Personal recollection from the author, JF). Generic producers in India estimated their API costs at about l,100/kg upon first generic introduction in 2005 (Personal communication, Mr D.R. Rao, Cipla). Currently, the API can be purchased for about 120/kg, a 13-fold decrease in cost of API in 17 years (import-export data at www.infodriveIndia.com). Notably, the volume demand of efavirenz in 2015 is also estimated at about 2,000 tons, since this drug is a standard component of first-line AIDS treatment in low- and middle-income countries. 

Pommier Y, Johnson AA, Marchand C (2005) Integrase inhibitors to treat HIV/AIDS, Nat Rev Drug Discov 4 236-248... 

The cost-effectiveness analysis of antiviral therapy has to be seen under the precondition that no long-term effects, such as drug resistance, occnr. Future analysis might show that we strongly underestimated the long-term costs of HIV/AIDS. 

The calculation of direct household costs of HIV/AIDS is quite difficult. First, resource consumption is hardly documented, so that patients have to be interviewed or be asked to keep household diaries for all expenditure due to their disease. Second, it is frequently not easy to allot a certain expenditure to a specific disease. Co-payments for drugs, practitioner, and hospital services as well as transport to and from the provider are easily allocated to the COI of this disease. But other direct household costs might be even higher, such as the costs of a special diet, but it is very difficult to analyze whether these costs are really incurred due to this illness. Studies demonstrate that direct household costs might be small in developed countries, but they might make up to 50% of the total COI in developing countries (Su et al. 2006). 

The economic impacts of HIV/AIDS disease have also been analyzed in Europe. Beck (1995) studied the AIDS-related costs in a national AIDS referral center in London. He concluded that share of total drug cost increased between 1985 and 1989 from 5.0% to 30.0%. The median survival time from the date of the diagnosis of AIDS was 14.6 months before the introduction of Zidovudine (1987) and 21.0 months afterwards. 

The number of studies for other countries is limited. Krentz et al. (2003) analyzed the provider costs of providing medical care to patients with HIV/AIDS in Southern Alberta Canada) between April 1995 and April 2001. The authors collected all patient-specific provider costs including the cost of drugs (HIV and non-HIV drugs), outpatient care (including physician costs and laboratory testing), and... 

Becker R, Shakur U (2001) The impact of drug comphance on the cost of treating HIV/AIDS in Africa, Value Health 4 439 140... 

Moatti JP, Spire B, Kazatchkine M (2004) Drug resistance and adherence to HIV/AIDS antiretroviral treatment against a double standard between the north and the south, AIDS I8 S55-S6I Moore RD, Chaisson RE (1997) Costs to Medicaid of advancing immunosuppression in an urban HIV-infected patient population in Maryland, J Acquir Immune Defic Syndr Hum Retrovirol 16 223-231... 

Anthony IC, Bell JE (2008) The neuropathology of HIV/AIDS. Int Rev Psychiatry 20 15-24 Anthony IC, Ramage SN, Carnie FW, Simmonds P, Bell JE (2005) Does drug abuse alter microglial phenotype and cell turnover in the context of advancing HIV infection Neuropathol Appl Neurobiol 31 325-338... 

Based on the information presented, create a care plan for this patient s HIV/AIDS. Your plan should include (a) a statement of the best drug combinations and reasons supporting each drug recommended, as well as any adverse effects or potential drug-related problems, (b) the goals of therapy, (c) a patient-specific, detailed therapeutic plan, and (d) a plan for follow-up to determine whether the goals have been achieved and adverse effects avoided. 

In contrast to profound immunosuppression, such as that which occurs in patients with HIV/AIDS or primary immunodeficiency diseases, exposure to immunotoxic chemicals or drugs is believed to be more likely to cause mild-to-moderate levels of immunosuppression (e.g., a 20% decrease in white blood cell counts). This review attempts to address, both qualitatively and quantitatively, the potential adverse health effects of moderate levels of immunosuppression. The following general conclusions can be surmised. 

The field of pharmacogenomics is still in its infancy. Its use is currently quite limited, but new approaches are under study in clinical trials. In the future, pharmacogenomics will allow the development of tailored drugs to treat a wide range of health problems, including cardiovascular disease, Alzheimer disease, cancer, HIV/ AIDS, and asthma. 

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