Fifth International Congress Drug Therapy in HIV Infection 22-26 October, 2000 Glasgow, UK

Therapeutic initiatives in Thailand

P. Phanuphak
Department of Medicine, Faculty of Medicine, Chulalongkorn Uiversity, The Thai Red Cross AIDS Research Centre and The HIV-Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand

Int Cong Drug Therapy HIV 2000 Oct 22-26;5:Abstract No. PL2.2
AIDS 2000, Oct 22-26;14(Suppl. 4);S2

Thailand has almost all antiretrovirals (ARV) licensed in the West but less than 20% and 5% of its population can afford the treatment of 2 and 3 ARVs respectively. Clinical trials offer the access to care for some patients. The first ARV trial in Thailand was in 1991 comparing QID and BID doses of AZT. It was followed by the establishment of HIV-NAT (HIV-Netherlands Australia Thailand Research Collaboration), based at Thai Red Cross Society in 1996. The primary objective of HIV-NAT is to perform high (GCP) standard clinical trials of various ARV regimens which might be cost-effective and economically viable for countries with moderate resources. Examples of such trials are comparison of half-dose and full-dose double nucleosides, switching of double nucleosides before failure is evident, triple nucleosides as HAART substitute and the use of baby ritonavir together with twice-daily indinavir. HIV-NAT also participates in international phase II/III/IL-2 trials and in pharmacokinetic study of nelfinavir in newborns.

In addition to these company-sponsored ARV trials, Ministry of Public Health (MOPH) of Thailand has created a network of MOPH hospitals throughout Thailand for the purpose of HIV clinical trials. MOPH uses its allocated ARV budget to supply trial drugs for this network instead of giving the drugs free to everyone like it did in the past with poor compliance. Besides several small investigator-initiated protocols, MOPH has created 2 large multicenter trials; AZT/ddI vs AZT/ddC and half-dose d4T vs fulldose d4T in combination with full-dose ddI vs AZT/ddI as follow-up of HIV-NAT 02 results. Currently, more than 25 MOPH hospitals participate in the MOPH network. The ultimate aim of the network is to create a group of physicians and hospitals who are interested to care for HIV patients as well as to strengthen their capacity in providing care and in keeping good medical records with GCP standards.

Unlike MOPH-sponsored trials, company-sponsored trials frequently encounter the problem of continuation of drug supply after the end of a trial. Roll-over protocols offer some solutions but more proactive and aggressive solutions are urgently needed. The commitment has to either come from the government or the pharmaceutical industry to guarantee life-long supply of affordable drugs to the trial participants.

There are several other therapeutic initiatives in Thailand. Prevention of mother-to child transmission (PMTCT) is another major activity. Several short-course AZT trials in Thailand have just been concluded. The results of these trials, as well as the Thai Red Cross donation campaign to prevent MTCT drive government’s decision to implement PMTCT nationwide. Import tax exemption and lower hospital pharmacy mark-up for AIDS drugs, local production of ARV and government’s price negotiation are among the therapeutic initiatives currently going on in Thailand. It is anticipated that price of ARV will be lower which will enable more patients to have access to treatment.

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2000-10-22
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Originally published in AIDS Volume 14, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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