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Clinton Foundation Makes AIDS Drugs More Widely Available: Initiative helps cut costs of anti-retrovirals in the developing world


USIS Washington File - April 3, 2008

Washington -- Fifteen years ago, a young specialist in pediatric infectious diseases watched, and mourned, as the number of infants born infected with the human immunodeficiency virus (HIV), a retrovirus that causes acquired immunodeficiency syndrome (AIDS), skyrocketed.

But now, Dr. Shaffiq Essajee works with health care providers and health officials in more than 20 countries to bring new drugs to children and families suffering the devastating impact of the HIV/AIDS epidemic. Since 2005, Essajee, as the senior adviser in pediatrics to the William J. Clinton Foundation's HIV/AIDS Initiative, has established pediatric HIV/AIDS treatment programs in dozens of countries in Africa and Asia, and worked with drug companies and international health organizations to get affordable HIV drugs to those infected in the poorest nations.

Two decades ago, doctors did not know how to prevent HIV transmission during pregnancy. But a groundbreaking medical study by the National Institutes of Health in 1994 showed that giving HIV-positive mothers zidovudine (AZT), an anti-retroviral, during pregnancy and delivery, and administering the drug to the baby for six weeks after birth reduced transmission of the virus from mother to infant by two-thirds. By 2000, some 90 percent of HIV-positive mothers and their newborns in the United States were treated with zidovudine. Pediatric AIDS cases plummeted.

The routine use of zidovudine (AZT) in pregnancy was only one part of the revolution in AIDS treatment that took place in developed countries in the mid-1990s. Discovery and approval of dozens of new drugs led to treating patients with three of four anti-retrovirals to prevent progression to AIDS. Called highly active anti-retroviral therapy (HAART), the "drug cocktail" became standard treatment for adult and pediatric HIV patients in most developed nations.

"But just as the HIV epidemic was becoming more manageable in the U.S." said Essajee, "over the same time period, HIV was spinning out of control in many parts of Africa." In 2000, Essajee, a native of Kenya, traveled to Mombassa, his hometown, to see the status of pediatric HIV treatment in the African nation's second-largest city. There, neither the prophylactic treatment of HIV-infected mothers with AZT nor HAART was widely known or available.

"The wards were full of HIV-positive children, but in 2000, there were no HIV clinics for children, no means of treatment, and no effective programs of pediatric HIV prevention," Essajee recounted. "The contrast between the happy, healthy children I treated in New York, who were living with HIV, and the thousands of infected children in Kenya, who were dying, was stark and irrefutable." Essajee secured a grant to establish Kenya's first pediatric HIV program in Mombassa, modeled on the program at Bellevue Hospital in New York. By the end of 2001, 200 children enrolled, but "still none of these children could be treated, as the cost of pediatric anti-retroviral therapy was astronomical," he said. He secured funds to buy drugs "for a handful of the sickest children." But it was not until 2002, when the Clinton Foundation began a partnership with drug companies to sell low-cost anti-retrovirals to the Third World, that Essajee was able to treat a significant number of Kenyans.

TRANSFORMING THE ANTI-RETROVIRAL MARKETPLACE In 2002, some 70 percent of the 40 million people infected with HIV lived in developing nations, but only 135,000 of them were in treatment because of the high cost and low availability of anti-retroviral drugs.

Today, that has changed. Over the last six years, the Clinton Foundation has played a key role in transforming the anti-retroviral marketplace from a low-volume, high-cost enterprise, into a high-volume, low-cost business, serving HIV/AIDS patients in 70 countries.

The initiative supports the "demand side" of the market, helping governments, hospitals and clinics like Essajee's in their prevention and treatment programs. In addition, it provides technical assistance to Third World governments to develop procurement and supply-chain management practices that will allow them to acquire and distribute large orders of HIV drugs and diagnostic tests effectively.

Equally important to the foundation's success are close relationships with the "supply side" -- the branded and generic companies that manufacture both first- and second-line HIV medications and diagnostics. By May 2007, the Clinton Foundation HIV/AIDS Initiative (CHAI) had agreements with manufacturers to offer 16 formulations of first- and second-line anti-retroviral drugs at reduced prices. In exchange, CHAI helps the pharmaceutical firms with demand forecasting, quality control and production support. CHAI also facilitates relationships between suppliers and Third World buyers. As a result, the cost of anti-retrovirals to the 70 countries in its consortium has dropped by an average of 45 percent.

In addition, Roche Pharmaceuticals recently signed an agreement with CHAI to cooperate on early infant diagnosis projects in 24 countries in sub-Saharan Africa. "Roche will supply testing kits and products for the collection and processing of dried blood samples to these countries," says Jane Erhart, a spokeswoman for Roche. These test kits allow diagnosis of the many infants in these nations born to mothers who do not know they are infected with HIV. Without treatment, 50 percent of these children will die of AIDS within two years, and 80 percent will die by the age 5.

"The Clinton Global Initiative has done a tremendous job bringing awareness and access to affordable anti-retroviral medication around the global," said Heather Bresch, chief operating officer for Mylan Laboratories, the parent company of Matrix, the largest supplier of generic ingredients used to make anti-retroviral drugs.

The number of patients in treatment has grown to about 2.5 million, a 185-fold increase since the initiative began in 2002. "But the number of untreated is still staggering," Bresch said.

Yet, doctors like Shaffiq Essajee, who battle HIV/AIDS every day, have become far more optimistic about controlling the disease since the Clinton Foundation's initiative began.

"A new future is emerging," he said, "A future in which HIV in children is another chronic disease which can be treated simply and effectively with affordable medication; a future which restores hope to families that were lost in an epidemic of despair."


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Information in this article was accurate in April 3, 2008. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.