Indian Low Cost Generics ARVs Save Millions Globally

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HIV Management and Low Cost Generics Save Millions Globally

The global AIDS Epidemic has completed 25 years of its devastating presence.

India though tops the world in HIV numbers; plays a savior globally by

ameliorating the sufferings of millions of HIV infected people and saving their

lives.

Peoples Health Organisation (India)- the first NGO that raised alarm against

AIDS in India in 1985 and championing the cause of 'Increasing Access to ART'

believes that today India has emerged as an asset and not a liability vis-Ã -vis

HIV/AIDS. This fact has been grossly ignored by the experts and the powers that

be in the melee of the ˜number game' - if India is No.1 or No.2 in HIV

infections, it is indeed an opportune time to take stock of the AIDS situation

and its medico-socio-economic impact on the human race across the globe

including India and Indian contribution in providing quality ARVs at affordable

price to the rest of the world.

Padmabhusan Dr.R.D.Lele recorded the first Indian AIDS case on 10 June 1986.

With 25 years of the AIDS epidemic, 20 years of diagnosis of first AIDS Case in

India, 10 years of ˜Highly Active Anti-Retroviral Treatment (HAART)and five

years of its availability at affordable price, we have reasons to project India

as a powerful country and not a poor-gullible 3rd world country.

Just imagine the world without India vis-Ã -vis AIDS? India- an Asset: Despite

topping the HIV infections in the world with estimates of 5.7 to 10 million,

India has a lot to offer to the rest of the world.

Its clinically oriented, comprehensive and holistic HIV care using few

laboratory tests has earned accolades. Coupled with affordable generic medicines

with 100% Bio-equivalence, at 5% of global cost, they are the most important

ingredients for much needed access to ARVs globally.

Indian pharma companies braved taking on the mighty Multi-National Companies

(MNC) lobby in fighting patents. Today the patent-owner MNCs have been left with

no option but to reduce prices for developing countries as also offering

voluntary licenses to Indian pharma; which have capacity to manufacture and

fulfill the global demand.

Indian conservative and wait-n-watch approach in starting ART has indeed been

blessing for HIV/AIDS patients as it improves quality of

life, increases survival, reduces cost and spare them from early onset of

drug-resistance.

The Indian culture of joint families and lasting marriages with faithfulness of

women folks have been an asset in providing psycho-social support and reduced

transmission. Kama-Sutra - an Indian art and science of making love - has a lot

to offer by adding sensuality to sexuality and reduces HIV transmission with its

rescription 'Many positions with one, better than one with many!' The age at the

first sex is higher in India.

What we have gained? If any epidemic hits- we focus on its negative impact, on

what we lost? Rarely do we talk of positive behaviour-change and lessons it

teaches the human race.

Sanity about morality, sexuality and sensuality, Sex education, Kamasutra,

Pre-marriage checks Blood-Blood Products safety: >20 Transfusion-Transmitted

Diseases are under scanner 'Safe barber practices' - only after HIV arrived;

though Barbers can transmit infections Lab./Hospital safety - Universal

precautions, exposing indifference of medical caregivers Importance of Safe

Pregnancy and preventing Mother to Child Transmission (MTCT) Clean needles

practices for Injection Drug Users (IDUs) Importance of Indian Pharma saving

millions and exposing MNCs with >1000% profits Knowledge of prevention and

treatment patterns of several portunistic

Infections Role of condom in preventing STDs: colour, flavours, textures; and

Female condom Attention to sex workers and mainstreaming marginalised

communities like Hijras, MSM No. of sex workers-sinking-all time low,80% in

Mumbai, STDs down by 80 to 90%

What India still needs to learn? If our foreign reserves are over 150 billion

US$, we pre-paid the ADB loans, do we need to run our National AIDS Control

Program(NACP) on clutches of foreign aid? If Bill Gates contributed 200 million

US$ for India, why can’t Indian business giants match it? High 'political

will' is needed to contain AIDS/TB beyond tokenism and lip-service.

We need to-Stop the jugglery of numbers and honestly accept that HIV is

widespread; Provide subsidised ART making its access universal; Move from

'Donor-Dependence' to 'Self-reliant' NACP; Evaluate support to NGOs and

replicate best practices ; Reduce vulnerability of women and children, Prevent

MTCT as an emergency; Focus on Youth and de-addiction.

One Pill a Day: Keeps AIDS at Bay! " While grappling with the Chickengunia and

Dengue panic all over, one of the positive achievements in medicineâ “the first

˜one-pill-a-day AIDS treatment Viraday should not get suppressed. It makes HIV

treatment cheaper, safer and easier. It is possibly the brightest news since the

AIDS

scourge began spreading its darkness across the world. Cipla's Viraday - a

generic equivalent of Atripla from the MNCs Bristol-Myers Squibb and Gilead

Inc., at 90% less cost - Rs.60,000/- per annum, per patient - is a combination

of three ARVs: efavirenz 600 mg, tenofovir 300 mg and emtricitabine 200 mg.

All these active ingredients are manufactured indigenously and the first such

formulation in India. The medical fraternity has long awaited this breakthrough,

as it will give a huge boost to adherence - how faithfully patients stick to the

treatment course advised by the doctor. It is a crucial issue in ART in order to

prevent HIV infection from advancing to AIDS. Also, if patients do not adhere,

the HIV can develop ARV resistance.

Viraday is patient-friendly - just once a day; it can be taken any time and is

free from the adverse effects of many other ARVs. Even the MNCs inadvertently

attributed success to Cipla, by calling their new combo 'Atripla' (Atr + ipla).

The MNCs released one after other ARVs globally from 1987 onwards and priced

them exorbitantly - basically meant for HIV patients of rich countries and rich

AIDS patients in the third world countries. Millions of HIV/AIDS patients died

awaiting access to ART wiping out populations of some of the African countries

with average life span falling to almost half.

No amount of protests and requests had any impact on the greedy MNCs. Indian

pharma took a lead and risk of inviting litigations, circumvented patents by

producing generic copies using reverse engineering and brought down the prices

to 5%, with same bio-equivalence. In 1996, on our advice Cipla made a

three-in-one combo pill to be taken twice daily that became one of the most

popular ART.

Ever since Cipla has been a fore-runner in harnessing its R & D to reduce the

" pill burden " for patients on ART. Though initially MNCs, opposed Indian

companies in courts and media, on the fictitious grounds labeling it as

third-rate copy-cat with poor quality and poor bio-equivalence. However,

impressed with the success of fixed-drug combinations, they started making

similar combos.

Ironically, when the ˜West copies the East', why apply different

yardsticks? Indian Pharma companies repeatedly reduced prices of various ARVs in

recent years to make them affordable for patients.

They must be lauded for saving millions of the lives of poor people across the

globe and keeping Indian tri-colour flying high.

BUT Model for India: Brazil - role model for state-run free HIV care; Uganda and

Thailand as role model for Prevention. Uganda’s prevalence of 15% in 1995 has

been brought down to 5% now-using high political will and ABC approach

Abstinence, Be faithful, Condom.

Thailand topped Asia in HIV prior to 1993, with >2% prevalence. Excellent

control has been achieved using AIDS Ministry concept and high-profile HIV

awareness and condom promotion campaigns. People in scientific and political

circles can look at India leading the show for the next couple of decades in HIV

management.

Together we can and we will make a difference!

Padmabhushan Dr.R.D.Lele, Sr. Physician

Prof. K C Mohanty, TB & Chest Physician

Dr.I.S. Gilada, Consultant in HIV/AIDS and Hon.Secretary-PHO

Dr.Jaideep Gogtay, Medical Director-Cipla

PHO,J.J.Hospital Compd,Mumbai-400008;

Tel.:23719020;Fax:23000016;E-mail: ihoaids@...

DR GILADA

e-mail: <gilada@...>