Humanitarian organisation Doctors Without Borders/Médecins Sans Frontières (MSF) has complained that the people living with HIV/AIDS in many Asian counties including India have been denied access to an improved version of the AIDS drug lopinavir/ritonavir by its sole manufacturer, Abbott Laboratories.

Pointing out that ritonavir is the best option for India's irregular power supply and unreliable storage conditions, MSF wondered why Abbot has not yet attempted to market the drug in India. "Although the UN has recently identified India as the country with the highest number of people living with HIV/AIDS in the world, the new version of the drug is still not for sale," it said. Lopinavir/ritonavir is an important second-line drug for people who have been on treatment for several years.

The new version of lopinavir/ritonavir, a second-line AIDS drug recommended by the World Health Organization, has critically important advantages over the old version, including lower pill count, storage without refrigeration, and no dietary restrictions. But without registration, the drug is virtually impossible to obtain at any price. In China, not even the old version is available, because although it is registered, Abbott has chosen not to market it in the country, MSF stated. The situation is the same in Thailand.

The Chicago-based company began shipping the new formulation to a limited number of MSF projects in Africa for $500-per-patient-per-year only after a cumbersome and time-consuming procedure. However, Abbott refuses to sell the drug to MSF for use in its programmes in Thailand and Guatemala and has dragged its feet with registering it in developing countries. The result is that the new formulation of lopinavir/ritonavir remains unavailable and unaffordable for the vast majority of patients who need it, MSF stated.

"By limiting its $500 price to the poorest of developing countries, Abbott isadopting a policy that deliberately excludes people living with HIV/AIDS in other developing countries," Dr David Wilson, of MSF in Thailand said.


According to MSF, there is a growing need in developing countries for second-line regimens for patients that have been on treatment for several years. However, there is great concern that national treatment programmes and funding agencies will not be able to afford the prices of these drugs, which are much higher than those of first-line regimens. In Thailand, Abbott charges at least $2,800 for the old version of lopinavir/ritonavir, which means that it costs roughly ten times more to treat a patient who needs to be switched to a second-line regimen containing this drug.

This is a classic case of how monopolies hurt patients, said Dr. Tido von Schoen-Angerer of MSF¹s Campaign for Access to Essential Medicines. "We need generic competition for these newer essential drugs, because it¹s the only way to make them affordable and widely available. It should not be up to a CEO in Chicago to decide who has access to a life-saving medicine".