Cost of AIDS drugs in Brazil, and more

November 12, 2007

Brazil's strategy of negotiating AIDS drug prices with multinational pharmaceutical companies and producing generic AIDS drugs locally saved that country's AIDS program approximately 1 billion US dollars between 2001 and 2005, according to research published in PLoS Medicine.

In a study from the Harvard School of Public Health, Amy Nunn and colleagues analyzed the costs of individual AIDS drugs in Brazil. They found that even though the generic drugs produced in Brazil were generally more expensive than similar drugs made elsewhere, by negotiating patented drug prices, Brazil has enjoyed lower prices for patented AIDS drugs than many other developing countries.

The researchers also analyzed aggregate costs of Brazil's AIDS drugs and found that Brazil's total AIDS drug costs have more than doubled in recent years and that the costs of producing generic drugs in Brazil has risen steadily over time. The study concludes that although the Brazilian model of producing drugs locally and negotiating prices initially saved Brazil $1 billion, drug costs rose rapidly as Brazil provided treatment to increasing numbers of people and the lives of people with HIV/AIDS became longer.

Although world leaders have set a target of universal access to AIDS treatment by 2010, little is known about the long-term costs of AIDS treatment in developing countries. Brazil's experience provides important information about how AIDS treatment costs are likely to evolve in other developing countries as efforts are made to provide universal access to life-saving drugs and as life expectancy for people living with HIV increases.

In 1996, Brazil became the first developing country to commit to providing free and universal access to AIDS drugs. Since then, Brazil's successful AIDS treatment program has become a model for the developing world, with 180,000 Brazilians receiving treatment at the end of 2006.

The study highlights economic consequences of Brazil's sometimes controversial policies. As a member country of the World Trade Organization that signed on to the Trade-Related Aspects of Intellectual Property (TRIPS) agreement, Brazil was required to recognize the intellectual property rights of pharmaceutical companies' patented AIDS drugs. As Brazil scaled up treatment in the late 1990s, the cost of treating AIDS patients rose quickly and the country took controversial public policy steps to reduce the cost of providing treatment to people living with HIV/AIDS. Brazil produces eight non-patented AIDS drugs locally, and since 2001 has challenged five multinational pharmaceutical companies about the prices of several patented AIDS drugs. To induce price reductions for patented drugs, Brazil has threatened to issue compulsory licenses (which under WTO terms allow countries facing a health emergency to produce patented drugs without consent of the company holding the patent) and in May 2007 issued a compulsory license for efavirenz, an AIDS drug for which Merck holds patent rights.

Citation: Nunn AS, Fonseca EM, Bastos FI, Gruskin S, Salomon JA (2007) Evolution of antiretroviral drug costs in Brazil in the context of free and universal access to AIDS treatment PLoS Med 4(11): e305.



Related image for press use:

- Caption: FarManguinhos drug production facility in Brazil (Photograph by Amy Nunn)

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Clinical protection from malaria closely associated with class of antibodies

Using data from malaria cases in Senegal, Pierre Druilhe and colleagues showed that the presence of a class of antibodies was strongly predictive of clinical outcome. There are important implications for vaccine research.

Citation: Roussilhon C, Oeuvray C, Muller-Graf C, Tall A, Rogier C, et al. (2007) Long-term clinical protection from falciparum malaria is strongly associated with IgG3 antibodies to merozoite surface protein 3. PLoS Med 4(11): e320.



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About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit


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