Sydney - A new report by Médecins Sans Frontières (MSF) shows dramatic price reductions for second-line antiretroviral treatment over the last year, largely stimulated by a compulsory license issued by Thailand. But the report also identifies a worrying trend: using the newer, less-toxic first-line combination, now recommended by the World Health Organization, raises the cost for patients by nearly 500 percent, from US$99 to up to US$487.

The report 'Untangling the Web of Price Reductions' was released today by MSF at the 4th International AIDS Society Conference in Sydney. "It's encouraging to see the price of second-line regimens finally starting to come down," said Karen Day, pharmacist with MSF's Campaign for Access to Essential Medicines.

"But we are worried that the lack of competition and dramatically higher prices for the newly-recommended WHO first line could mean that people in developing countries may not be able to benefit from improved treatment that has been widely available in wealthy countries for years."

An MSF analysis of Brazil and Thailand's efforts at providing universal access to antiretroviral therapy shows that compulsory licenses have been far more effective in bringing prices down than negotiating price reductions with companies or relying on companies' differential pricing schemes.

In January 2007, Thailand issued a compulsory license to overcome the patent barrier on the important drug for use in second line, lopinavir/ritonavir, allowing the country to legally either import the drug or produce it locally. "Just one year ago, treating a patient with a second-line regimen containing lopinavir/ritonavir in Thailand cost $2,800 per year," said Kannikar Kijtiwatchakul, MSF Campaigner in Thailand.

"Thanks to competition since the compulsory license, treating that same patient with a second-line regimen will now cost $695 - four times less. But this is still far too expensive for the majority of people in Thailand, where the average annual salary is $1,600."

MSF's experience trying to obtain newer AIDS medicines over the past two years has shown that significant delays persist between when newer treatments become available in wealthy countries, and when they become available in the developing world. "I work in Sydney and also have been treating patients with AIDS in countries like Malawi and Mozambique and the gaps I have witnessed are alarming," said Dr Alexandra Calmy, HIV/AIDS Advisor for MSF's Campaign for Access to Essential Medicines.

"At this conference in Sydney, we're seeing presentations on several promising drugs. These drugs should be available in Africa, Asia and Latin America at the same time as they are marketed in rich countries, not only after years of fighting for access to them. This means including the needs of people living in developing countries into the R&D plans from the beginning."