Brazilian experience of AIDS cocktails

AIDS continues to be a staggering global public health problem. The World Health Organization estimates that two million people in developing countries receive treatment known as HAART (highly active antiretroviral therapy), more commonly known as "AIDS cocktails."

This number represents just 25% of those in need of treatment in these countries. However, little is known about the long-term costs associated with providing drugs to AIDS patients in developing countries. To study those long-term cost trends, researchers from the Harvard School of Public Health have performed the first detailed analysis of AIDS drug cost trends in Brazil. The results appear in the November 13, 2007 issue of the journal PLOS Medicine .

Brazil has one of the developing world's oldest, largest and most successful AIDS treatment programs and has been treating AIDS patients for more than a decade. Brazil provides free and universal access to AIDS drugs and is a model for other countries scaling up AIDS treatment.

The results showed that, although costs for Brazil's locally produced generic antiretroviral drugs (ARVs) increased from 2001 to 2005, the country still saved approximately $1 billion in that time period through controversial price negotiations with multinational pharmaceutical companies for patented ARVs. Since 2001, Brazil has been able to obtain lower prices for patented ARVs by threatening to produce AIDS drugs locally. Though these negotiations initially prompted major declines in AIDS drug spending, HAART costs in Brazil more than doubled from 2004 to 2005. The steep increase reflects the fact that more people living with HIV/AIDS began treatment and are living longer. The increase also reflects the challenges associated with providing complex, costly second- and third-line treatments as people develop resistance to first-line drugs, live longer and require more complex treatment regimens.

“Although Brazil has saved large sums by negotiating with pharmaceutical companies, it faces significant challenges with the rising cost of providing universal access to AIDS treatment,” said Amy Nunn, lead author of the study and formerly a researcher at HSPH. “Brazil's challenges may foreshadow the rising costs other developing countries will face as they work to provide universal access to treatment for all people living with HIV/AIDS. The Brazilian experience suggests that if the global community is truly committed to providing high-quality treatment to all people living with HIV/AIDS, far more resources must be mobilized to achieve this important goal.”

Joshua Salomon, associate professor of international health at HSPH, was the senior author of the study.

The study was financed by the U.S. Departments of Education and State. Salomon received support from the National Institute on Aging and the Bill and Melinda Gates Foundation. Co-author Francisco I. Bastos received funding from the Oswaldo Cruz Foundation.