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Use of antiretroviral therapy in resource-limited countries in 2007: up-take of 2nd-line and paediatric treatment stagnant
Presented by Françoise Renaud-Théry, Switzerland.
F. Renaud-Théry1, B. Dongmo Nguimfack1, M. Vitoria1, E. Lee2, J. Perriens1
1World Health Organization, Department of HIV and AIDS, Geneva, Switzerland, 2Consultant, Geneva, Switzerland
Background: In July 2007, the AIDS Medicines and Diagnostics Service (AMDS) of WHO repeated its 2006 survey on the use of antiretroviral (ARV) therapy in developing countries.
Methods: Questionnaires covered the use of first- and second-line regimens in adults and children and first- to second-line switching rates. The proportions of ARVs used, weighted for volume, was correlated with 2006 WHO guidelines. ARV demand was compared with the production capacity of active pharmaceutical ingredients (API), reported by the producers in 2007.
Results: Thirty countries, representing 63% of patients on treatment in developing countries as of December 2006, responded. Of those patients, 93% were adults and 7% children. The ratio of first:second-line use was 97:3 among both. For adults, 90% of those on first-, and 60% of those on second-line reportedly used WHO recommended regimens. Among first-line users, d4T/3TC/NVP (51%) and ZDV/3TC/NVP (14%), and among second-line users, ABC/ddI/LPV-r (15%), and ZDV/ddI/LPV-r (14%) were the most commonly reported regimens. Among children, d4T/3TC/NVP (42%) was the leading first-, and ZDV/3TC/LPV-r (24%) the leading second-line therapy. Only thirteen countries reported on their switching rate, with first year switching rate estimates ranging from 1% to 13%. Tenofovir use was reported in 1.5% of first- and 14.2% of second-line adult regimens, compared to no reported use in 2006, and the uptake of paediatric treatment, while increasing in absolute volume, was stagnant relative to adults (7% and 8% in 2007 and 2006, respectively). Last, present API production capacity is sufficient to meet current ARV demand.
Conclusions: This survey documents the slow uptake of adult second-line treatment and of pediatric treatment in developing countries. The low compliance with WHO treatment guidelines on second line treatment suggests that there are difficulties with its rational use.
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