As the fight against HIV/AIDS continues, researchers and health clinicians are looking towards a future that will see low to middle income countries having access to better medication and more cost-effective drugs.
While the current first-line regimen of antiretroviral drugs (ARVs) is the best it has ever been, researchers have started to push for Dolutegravir to be part of the first-line regimen.
is in a relatively new class of HIV drugs called integrase inhibitors.
At the moment, research has shown that creating drugs with a lower dosage could potentially save the country $3-billion by 2025. In countries like South Africa, where 6-7 million people are HIV+, (18% of the world total) it would go a long way in making treatment more accessible to the poorest of the poor.
The introduction of Dolutegravir drug would allow people to stay on first-line regimens for longer, allowing them to skip the complications that come with medication available for the second and third-line regimens. Moreover, this would allow patients a more cost-effective treatment plan, as costs of the second and third-line regimen are very highly priced. Dolutegravir is most likely to replace efavirenz in South Africa’s first-line ARV regimen. While efavirenz is generally a good drug, it causes disturbing psychological side effects in a small percentage of people.
While dolutegravir is still under patent, South Africa is one of a number of countries that will be able to access cheaper generic versions of the drug due to an agreement that the drug’s maker GlaxoSmithKline made with the Medicines Patent Pool.
Professor Francois Venter, Executive Director of the Wits Reproductive Health and HIV Research Institute, briefly outlined the benefits of drug optimisation, for the following groups: patients, public health and the government. Patients would benefit greatly in that, they would have less side-effects, their dosing regularity would be lower, (taking medication only once a day) and the size of tablets would be smaller, as would the dosage. There would also be a greater level of ‘resistance forgiveness’ in that adherence rules could be a little more lax.
With regards to public health, drug optimisation would go a long way in the case of preventative measures. Research has shown that, where people were taking their ARV’s there were lower levels of new infections. Venter went on to explain that where people were taking their ARVs, levels of tuberculosis (TB) infection rates decreased.
In terms of the government, drug optimisation would allow costs to come down, in that active pharmaceutical ingredients would be cheaper and the supply lines of creating the medications would be much shorter and therefore cost less.
The biggest challenge at the moment lies in a lack of research with regards to the effects of Dolutegravir on pregnant women as well patients infected with TB. While it makes financial sense there is much work to be done in the research field to see exactly how the new drug regime would affect these key groups.
Venter asserted that South Africa is in a good space at the moment because there is a significant cost benefit, and there are drugs that contain fairly low toxicity levels. Even so, studies and research continue so rapidly, it is important to keep looking forward to understand how drug regimens can be bettered.