Burnet Institute, Melbourne, Victoria, Australia.
Accident and Emergency Medicine, Homerton Row, Clapton, London.
AIDS. 2021 Dec 15;35(Suppl 2):S197-S203. doi: 10.1097/QAD.0000000000002983.
The Joint United Nations Programme on HIV/AIDS aims for HIV testing, treatment and viral suppression rates to be 95%--95%--95% by 2025. Patented drug prices remain a barrier to HIV treatment. Generic alternatives are being produced and exported from countries without patent barriers at a fraction of the cost.
We collated export records of active pharmaceutical ingredient for HIV drugs to estimate the minimum costs of production. Using epidemiological data describing national HIV epidemics, we calculated the cost to treat 164 countries at 95%--95%-95%. Using weighted log-linear regression models, we estimated the mother-to-child transmissions (MTCTs), HIV-related deaths and new HIV infections preventable every year by increased treatment.
We estimated that TDF/3TC/DTG could be produced for $59 per person per year. At this price, the 164 countries in our analysis could be treated at 95%--95%--95% for $2 billion a year, preventing 66 308 MTCTs, 241 811 HIV-related deaths and 631 398 new HIV infections every year. In comparison, global expenditure on HIV pharmaceuticals in 2019 was $28 billion.
At $2 billion/year, the 164 countries in our analysis could be treated for the price of 4 weeks of current global sales. Global access to generic alternatives could reduce expenditure and improve clinical outcomes.
联合国艾滋病规划署的目标是到 2025 年，艾滋病毒检测、治疗和病毒抑制率达到 95%-95%-95%。专利药品价格仍然是艾滋病毒治疗的障碍。在没有专利障碍的国家，仿制药正在以成本的一小部分生产和出口。
我们整理了艾滋病毒药物的活性药物成分出口记录，以估算最低生产成本。利用描述国家艾滋病毒流行情况的流行病学数据，我们计算了以 95%-95%-95%的比例为 164 个国家治疗的费用。使用加权对数线性回归模型，我们估计了每年因治疗增加而可预防的母婴传播（MTCT）、艾滋病毒相关死亡和新的艾滋病毒感染。
我们估计替诺福韦/拉米夫定/多替拉韦每人每年可生产 59 美元。以这个价格，我们分析的 164 个国家每年只需 20 亿美元就可以达到 95%-95%-95%的治疗标准，每年可预防 66308 例母婴传播、241811 例艾滋病毒相关死亡和 631398 例新的艾滋病毒感染。相比之下，2019 年全球用于艾滋病毒药物的支出为 280 亿美元。
以每年 20 亿美元计算，我们分析的 164 个国家的治疗费用仅为当前全球销售额的 4 周。全球获得仿制药替代品的机会可以减少支出并改善临床结果。
