Firstline Treatment Choices Proving Challenging for African ART Programs

According to Aidsmap, African countries are facing serious financial and practical dilemmas over implementing recent World Health Organization (WHO) guidelines urging a shift away from d4T-based combinations for firstline antiretroviral treatment.

The WHO’s revised guidelines for adult antiretroviral therapy, published last November, recommended that d4T-based treatment should be phased out wherever such a move was practical and affordable, and replaced with a firstline regimen based on either AZT or tenofovir, since either drug has proved better tolerated, Aidsmap said.

Tenofovir is currently unaffordable for most countries, but that is set to change, according to Anil Soni of the Clinton HIV/AIDS Initiative. He said that four manufacturers will have submitted dossiers for WHO prequalification of generic versions of Atripla (tenofovir, 3TC and efavirenz) by the end of the year, and eight manufacturers will have submitted generic tenofovir tablets by the end of the year, according to Aidsmap.

As more products become available the prices will be driven down, although tenofovir and efavirenz-based combinations will always remain more expensive because they contain a larger volume of chemicals and the raw materials required for their manufacture are more expensive than d4T and nevirapine, according to Aidsmap.