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CHINA :: Scaling the Wall to Provide HIV/AIDS Treatment Researchers, AIDS specialists, non-government organisations and people living with HIV/AIDS groups will be meeting in Bangkok from 11th to 16th July at the bi-annual International AIDS Conference, one of the key conferences for those involved in HIV/AIDS worldwide. Médecins Sans Frontières is currently providing HIV/AIDS treatment for 13,000 patients in 25 developing countries, and will be sharing its experiences in Bangkok. Médecins Sans Frontieres’ participation in the conference will include conducting satellite meetings and skills building workshops, as well as numerous presentations on our work in the field. During the Bangkok conference, Médecins Sans Frontières will seek to raise awareness of the need for more research to simplify HIV/AIDS treatment in resource-poor settings, as well as the need for antiretroviral fixed-dose combination treatments (combining drugs into one pill) to treat children with HIV/AIDS. The following stories of patients from the Médecins Sans Frontières’ HIV/AIDS program China illustrate just how urgent these needs are today. While treatment of people living with HIV/AIDS has started in China, only a handful of the estimated 840,000 HIV+ people have access to it. Scaling up of HIV/AIDS treatment in China can only begin to be an achievable goal once several key obstacles to access are overcome. Too Many Pills For someone who has not been treated for HIV/AIDS before, the World Health Organisation recommends a ‘first-line’ treatment of three antiretroviral drugs: stavudine (d4T) or zidovudine (AZT), lamivudine (3TC) and efavirenz (EFV) or nevirapine (NVP). In many countries, this triple combination of ARVs is combined into one tablet – known as a “fixed drug combination” or FDC. There are generic versions of triple FDCs that have been tested for quality by the WHO, and Médecins Sans Frontières uses these FDCs in many of its HIV/AIDS treatment projects worldwide. FDCs simplify treatment by significantly reducing the number of pills needed to be taken daily. Unfortunately for Yam Him, these FDCs are not available in China. So instead of taking 2 tablets per day using FDCs, Yam Him must take 10 pills a day. If Yam Him develops any opportunistic infections, which commonly occur in people with HIV/AIDS, then this daily pill burden could more than triple. Taking so many pills per day for the rest of your life would be a major burden for anyone to undertake. However, adhering to treatment is critical, as partial or erratic doses will lead to resistance to the medication and ultimately treatment failure. The simpler the treatment, the more chance that the patients will continue to take their medicines. So why aren’t FDCs for treating HIV/AIDS available in China? This is because the pharmaceutical company GlaxoSmithKline (GSK) currently holds the patent for 3TC in China. The patent means that generic FDCs which include 3TC, or even generic single doses of 3TC, can neither be produced locally nor imported. Meanwhile the Chinese generic manufacturer Desano Shanghai has been producing the raw materials for 3TC and selling these to GSK. GSK does market 3TC in China – but only combined with another drug zidovudine (AZT) as a dual-therapy FDC tablet (marketed as Combivir ®), or in a dosage which is suitable for treating hepatitis B but not recommended for HIV/AIDS. The lack of access to a generic triple FDC means that ARV treatment in China following WHO recommendations, costs Médecins Sans Frontières five times what it does for the same treatment in Cambodia, where generic FDCs are available. The barrier created by the GSK patent on 3TC is an urgent issue that needs addressing in order to facilitate access to simple and affordable HIV/AIDS treatment – necessary prerequisites for scaling-up treatment in China.
WHAT ABOUT THE HIV POSITIVE CHILDREN? Staff at the CDC/MSF HIV/AIDS clinic have done their best to make the place as welcoming as possible. The patient waiting room is cheerful, with posters on the walls, brightly coloured chairs and tables and a television showing the latest HIV prevention and treatment videos. A hospitable place you would think for adults and children alike, except that the friendly atmosphere belies a grim reality that is faced by the HIV positive children who enter through the clinic’s doors. One such child was Wai Gai*. This 8-year old boy was adopted by two farmers
and lived with them in a poor rural village. Wai Gai was highly intelligent and
even spoke some English. Earlier this year Wai Gai suffered from meningitis and
lost his sight and hearing as a result. While being treated for meningitis, he
was diagnosed as being HIV positive. This had not been picked up during Wai Gai’s
many previous visits to hospital. Following the HIV diagnosis, Wai Gai’s
family had to sell many of their possessions to pay for the costly, but mandatory,
Western Blot HIV confirmation test – without the test, noone is allowed
to access HIV treatment in China. By the time Wai Gai arrived at the CDC/MSF clinic,
Wai Gai had a fever and cough, and was extremely thin. He weighed only 15 kilograms
– the same weight as an average three-year old in China. Luckily Wai Gai
was old enough and still able to swallow tablets, which the doctors gave him to
treat an infection that was attacking his body. But he also urgently needed ARVs,
which would have been able to save him if they were available in paediatric doses
and had he not already been so ill. Very ill and without access to optimal ARV treatment, Wai Gai had to visit three hospitals before the last one - which didn’t usually treat children - finally admitted him. In China, lack of education about HIV/AIDS among general health workers has meant that people with HIV/AIDS often experience discrimination within the health system. Sadly Wai Gai died shortly after being admitted – without timely access to optimal ARV treatment that exists in other countries and that could have enabled him to live and grow up with HIV/AIDS instead of dying from it. The stark reality is that this will continue to be the fate for the growing number of HIV positive children in China until quality, affordable paediatric HIV/AIDS medicines become available. The patent on 3TC and lack of availability of paediatric ARVs are by no means the only access-related issues facing China. There are also obstacles to accessing Efavirenz (EFV) and Stavudine (d4T), which are both also used in first-line HIV/AIDS treatment. EFV is under patent in China and is only available at a very high price. This puts it out of reach of government treatment programs, let alone individual patients struggling to afford treatment. d4T is not available in the right dosages for treating people with low bodyweight. And after a few years, as patients need to move to second-line treatment, the options become even narrower. There are no second-line treatments available in China at all. These numerous obstacles only serve to illustrate that the struggle for HIV/AIDS treatment access in China, let alone scaling-up of this treatment, has only just begun.
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