Free HIV medicines must be given to all, not just to some

September 12, 2005

In some poor countries, free life-saving HIV medicines are being given preferentially to patients who have never taken them before (so-called 'treatment-naïve patients'), which could have disastrous consequences, says a team of researchers in Uganda.

Writing in the open access international medical journal PLoS Medicine, Robert Colebunders and colleagues from Makerere University, Kampala, give four reasons why limiting free antiretroviral medicines (ARVs) to treatment-naïve patients is problematic.

First, they say that "patients are quick to share information, and rumours spread fast regarding ways to obtain free ARVs. When patients learn that ARVs are being given at no cost only to treatment-naïve patients, they may not disclose that they have taken ARVs in the past ... Such withholding of information may result in clinicians choosing inappropriate ARVs, thereby putting patients at risk of adverse effects or of development of [drug] resistance."

Second, the authors say that forcing some patients to pay for ARVs makes it less likely that patients will obtain the drugs and take them regularly.

Third, programs that only give free ARVs to treatment-naïve patients can be slow to enrol patients into treatment. In contrast, say the authors, patients already known to be on treatment, and who are sticking to the treatment regime, can be enrolled more quickly and with less effort.

Finally, the authors believe that "selecting only ARV-naïve patients for free ARVs raises a human rights issue. Can treatment be denied to those who have somehow found money to initiate therapy--often forestalling their demise--and who are now struggling to pay for ARVs?"
Citation: Colebunders R, Kamya M, Semitala F, Castelnuovo B, Katabira E, et al. (2005) Free antiretrovirals must not be restricted only to treatment-naive patients. PLoS Med 2(10): e276.

Keith McAdam
The Infectious Disease Institute
Makerere University
Kampala, Uganda


All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere--to read, download, redistribute, include in databases, and otherwise use--subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.


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