amfAR, The Foundation for AIDS Research

Running Out of Treatment Options

by Annette Sohn, M.D., Director of TREAT Asia

Annette SohnThe medicines we use for first-line antiretroviral therapy (ART) in low-income countries are now as inexpensive as $66 per patient per year for the more toxic d4T-based regimens and $179 per year for the less toxic and once-daily tenofovir and efavirenz regimen ( However, when these medicines no longer work to control the virus due to drug resistance, patients need to take second-line regimens that cost around $440 per year. Should that fail, third-line regimens may cost as much as $2,700 per year. While very few of the almost seven million people on ART are currently using secondline regimens, drug resistance is practically inevitable. This means that one day, people will need those third-line regimens.

For a small but growing number of children in Thailand, that day is today. HIV-NAT is leading a national study of pediatric third-line ART in eight centers. Of the 44 children enrolled, nine (20 percent) are already failing third-line regimens. For these nine children, there is nothing left in the Thai Red Cross AIDS Research Centre pharmacy that will work to suppress their HIV.
We are not prepared for this—for telling patients that we have run out of ways to keep them alive. What can we say to families who have worked so hard to pick up their medicines on time, to give their children bad-tasting powders and pills every day, all while struggling with stigma and discrimination? Unless we can create broader access to newer antiretroviral drugs, the answer to that may be nothing.