In some poor countries, free life-saving HIV medicines are being given preferentially to patients

In some poor countries, free life-saving HIV medicines are being given preferentially to patients who have never taken them before (so-called 'treatment-naive patients'), which could have disastrous consequences, says a team of researchers in Uganda.

Writing in the open access international medical journal PLoS Medicine, Robert Colebunders and colleagues from Makerere University, Kampala, give four reasons why limiting free antiretroviral medicines (ARVs) to treatment-naïve patients is problematic.

First, they say that "patients are quick to share information, and rumours spread fast regarding ways to obtain free ARVs. When patients learn that ARVs are being given at no cost only to treatment-naïve patients, they may not disclose that they have taken ARVs in the past … Such withholding of information may result in clinicians choosing inappropriate ARVs, thereby putting patients at risk of adverse effects or of development of [drug] resistance."

Second, the authors say that forcing some patients to pay for ARVs makes it less likely that patients will obtain the drugs and take them regularly.

Third, programs that only give free ARVs to treatment-naïve patients can be slow to enrol patients into treatment. In contrast, say the authors, patients already known to be on treatment, and who are sticking to the treatment regime, can be enrolled more quickly and with less effort.

Finally, the authors believe that "selecting only ARV-naïve patients for free ARVs raises a human rights issue. Can treatment be denied to those who have somehow found money to initiate therapy--often forestalling their demise--and who are now struggling to pay for ARVs?"