One of the many confounding things about the AIDS epidemic is the radical shift of the HIV disease burden to populations of countries with the least ability to payfor therapy. That creates a number of dilemmas and conundrums. One, those infected in developed nations with the ability to pay need very much for pharmaceutical companies to continue investing in research for new drugs to combat HIV, particularly as resistance to therapy spreads and because, as yet, there is no cure or vaccine available, both of which would be very nice to have.
The vehicle by which industry makes profits on drugs is called a patent. A member of the pharmaceutical industry looks at a patent as a means to protect intellectual property – to provide a profit and to allow for reinvestment of some of that profit into new research because no one else can manufacture a copy of the drug, thereby letting the drug be marketed without low-cost competition. An international health advocate, though, may look at that same patent as a means to a different end – that of providing wider access by breaking the patent and allowing cheaper copies to be produced. The patent represents something very different to different stakeholders.
That introduction is necessary to help make clear why the news that India has granted a patent to an HIV drug is such interesting news. Bloomberg reports that India has granted Pfizer India a patent on Salzentry (mariviroc), a second-line therapy. (Second line means that it is used after the initial round of drugs finds the virus resistant and in need of new therapy.) Apparently this is the first time India has granted a patent to an overseas manufacturer for HIV therapy.
It makes sense on the one hand, since more and more patients in India will be in need of second line therapies. However, unless the drug is priced at near generic prices either by the company or through negotiations with the government, it is difficult to see how widespread it may be employed. Which takes us back to the conundrum.
And, this has ramifications beyond HIV – but for other important, but expensive drugs such as cancer therapies as evidenced by the patent case involving Glivec and Novartis, which could be a topic of a whole other article.
Many eyes will be on the launch of this drug in India, and in particular, it will doubtless be a matter of interest at the 2008 International AIDS Conference (which meets biannually) being held in Mexico City this year, for it will have ramifications not only in India, but on the pricing structure of many HIV medicines to follow.