FORUM: Generic AIDS drugs the best hope for many

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Cheap, safe, generic antiretroviral (ARV) drugs are the best hope for millions with HIV/AIDS in the developing world.

James Glassman asserted that using generic antiretroviral (ARV) drugs to treat HIV/AIDS in poor countries is in "shambles," (Commentary, Nov. 17).

Let me tell you of Joyce Cheelo and her cousin, Nawa Mutimba. Both live in Zambia, are 28, mothers, subsistence farmers and have HIV/AIDS. They are patients of the Salvation Army/AIDS Health-care Foundation (AHF) Muka Buumi (Mother of Life) clinic and have given me written permission to use their stories. After long, debilitating illness, they are alive and well today for one reason: they began a regimen of cheap, effective, generic ARVs in early October of this year.

Zambia is estimated to have close to 1 million cases of HIV/AIDS. But fewer than 10,000 get ARV treatment (ART). Because generic ARVs are one-third the price of brand-name medicines, three times as many patients can be kept alive by using generics. So Zambia has chosen to use generic drugs and Joyce and Nawa get to live.

It is ludicrous for Mr. Glassman and the Hudson Institute to claim generics aren't less expensive. The Hudson study is flawed and incomplete because it relies on a single ARV price list for one organization and does not compare prices of most fixed-dose combinations (FDCs). Generic FDCs combine two or three different ARV drugs. For example, the price of the most widely used ARVs, Triommune and Triviro ($253 per patient for year) should have been compared to brand prices for its components ($555 per patient yearly, according to the report). However, because there is not a branded FDC to compare with Triommune, as the components are manufactured by different brand companies, this ratio is excluded from the analysis.

Despite efforts by some of the branded drug companies, the World Trade Organization rules allow poor countries during health emergencies to import generic medicines.

Since that loss, some of the drug companies and their allies have engaged in a cynical campaign of deceptions to discredit generics. There is simply no evidence the generic drugs now used are defective. AHF has used generic drugs for three years in Africa and Central America without problems.

Doctors Without Borders released a study of their patients this year showing no differences between those using generics and those using brand. The drugs' efficacy, in fact, is monitored by various agencies, including the WHO, the governments of the countries using the drugs, and by large organizations (like AHF) that use them. This includes a vast amount of data monitoring patient health outcomes.

The delisting of the Ranbaxy drugs from the WHO list shows the process is working. No evidence has emerged that the drugs themselves are faulty. In addition, the assumption that branded equals safe is fallacious. Consider the recalls of Rezulin in 1997 and Vioxx this year.

More than 20 million people in poor countries have HIV/AIDS today. Only a handful have access to lifesaving treatment. Abandoning cheap generics in favor of expensive branded drugs would be a death sentence for millions.

Only two months ago, Joyce and Nawa were both too sick to work their small farms, gather firewood, fetch water from the village well or cook for their children. Without the inexpensive generic ARVs their government purchases from an Indian company, they would surely have died. Today, they feel good and can care for themselves and their families. They have hope.

Moving from cheap generic to expensive brand-name ARVs in poor countries would consign millions with HIV/AIDS to a world without hope.

CLINT TROUT

Associate director, international policy

AIDS Health-care Foundation

Los Angeles