Copyright 2002 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2002
To the Editor: In their Special Communication,
Dr Attaran and Mr Gillespie-White1 claim
that the major bottleneck for access to antiretroviral drugs in Sub-Saharan
Africa (SSA) is the lack of financing mechanisms, rather than patents. The
combinations zidovudine/lamivudine/nevirapine or stavudine/lamivudine/nevirapine
are often considered among the most appropriate for developing countries because
of a relatively simple dosing schedule and an acceptable toxicity profile.
However, Attaran and Gillespie-White found that patents on zidovudine block
these combinations in 33 of 53 countries they surveyed, and that patents also
blocked nevirapine in 25 of these countries. Patents on antiretroviral medications
conferred monopolies and ensured extremely high pricing on the world market
until 2000. This surely has caused a significant delay in thinking in terms
of access to therapy in SSA. Until recently, in the light of a yearly drug
cost of $10 000 per patient, few would consider the use of antiretroviral
medications in SSA. However, the price of branded triple therapy combinations
in SSA recently has fallen to as low as $712 per patient per year.2
Boelaert M, Lynen L, Van Damme W, Colebunders R. Do Patents Prevent Access to Drugs for HIV in Developing Countries?. JAMA. 2002;287(7):840–843. doi:10.1001/jama.287.7.839
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