Prices of CD4 assays and viral load tests must be reduced for developing countries

Editor—Wise has reported that GlaxoSmithKline is to cut the price of some drugs in developing countries.¹ For over a decade antiretroviral treatment has been available to patients in the United States and Europe. Because of the extent of HIV infection in the developing world, however, the cost of these drugs was way beyond the reach of the government treasuries in the world's poorest countries. As a result there was the ethical dilemma of “patents before patients,” of life for developed countries and death for developing countries.

After worldwide protests led by South Africa, pharmaceutical companies have now decided to lower their drug prices considerably—indeed, by as much as 90%. This certainly was welcome news for us in the Caribbean. On the other hand, as the drugs are to be taken indefinitely some of us in developing countries may still have problems to afford them, even at that landmark reduction in prices.

But this is only part of the therapeutic dilemma. Certain infrastructures will have to be in place to make treatment more accessible and to ensure compliance with treatment: non-compliance may quickly lead to an increase in drug resistant viruses. Proper use of antiretroviral drugs requires laboratories capable of measuring viral loads and CD4 counts and, indeed, a convenient central laboratory for testing for drug resistance. Unfortunately, this is an equally unaffordable part of HIV treatment in developing countries. In the Caribbean the cost of measuring CD4 counts, for example, is £100 ($150), and for viral loads it is £80-£100 ($120-$150)—per test.

Obviously, therefore, the largesse of the pharmaceutical companies will have to be similarly matched by the companies that make and market CD4 assays and viral load tests. This has to be addressed urgently, otherwise the risk of the spread of blood resistant viruses worldwide will be added to the futility of offering cheaper drugs to some of the poorer developing countries. The cost of treatment may differ between developed and developing countries, but the standard of treatment should not.

I call on all governments from developing countries—in fact, the entire international community—to address this problem as a matter of urgency.