The coming weeks might bring major progress in the war against HIV/AIDS. A drug called Truvada already treats the disease. By June 15, American regulators are expected to approve its use to prevent the transmission of HIV as well. An FDA panel recommended Truvada for preventive use, to protect healthy people from contracting the virus. The past 30 years have produced several triumphs. New drug treatments transformed a fatal disease into a chronic one. They also have made HIV a big business. Sales of antiretroviral drugs in America and the five biggest European markets reached $13.3 billion in 2011. America is the rich world's biggest market, with 841,000 patients diagnosed.
Research has yielded more than two dozen HIV drugs. In 1987 Burroughs-Wellcome, now part of Glaxo Smith Kline, introduced the first one, tackling an enzyme that helps the virus progress inside human cells. In 1995 Hoffmann-La Roche, a Swiss drug firm, launched the first protease inhibitor, which interrupts the virus at a later stage of replication. Today different medicines are combined to suppress resistance or reduce side effects. The rise of combination therapy has brought a flurry of cross-licensing, as companies strike deals to sell each other's drugs in carefully calibrated cocktails.
One company stands out: Gilead. A late entrant to the HIV race, the California firm quickly took the lead. Its strategy was simple: The more convenient the treatment, the better. In 2004 Gilead launched Truvada, a once-a-day, one-pill combination of two drugs. In 2006 it introduced Atripla, a once-a-day, one-pill combination of Truvada and another treatment. Atripla's average wholesale price in America is nearly $25,000 per patient, per year. In 2011 its global sales reached $3.2 billion.
More than 60 percent of HIV drugs in America are bought with public money and patients are rarely pressed to buy the cheapest pills, as they might be if they had another disease. Distributing drugs in poor countries is harder. A decade ago hardly any poor people could afford them. At first drug companies handled this badly. In 1998, 39 big Western firms sued South Africa to protect their HIV patents. Global uproar ensued, and the firms backed down in 2001. Then two things changed.
First, rich countries started donating vast sums to fight AIDS in poor ones. In 2000 there was less than $2 billion for HIV programs each year. By 2010 there was $15 billion. Second, the price of AIDS drugs plunged. In May 2000, a year's "triple cocktail" therapy cost $10,000 or so. By 2011 the same pills sold for $62 in poor countries. The Plan for Aids Relief buys generic versions of patented drugs, which may be supplied only to poor countries. Despite the subsidies and the plunge in prices, less than half of those infected with HIV take HIV drugs. Those who do, however, live a long time, and they have to keep taking the pills. There is also a trade-off between more drugs and better ones: Most patients in poor countries get outdated pills, according to Medecins Sans Frontieres.
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Research has yielded more than two dozen HIV drugs. In 1987 Burroughs-Wellcome, now part of Glaxo Smith Kline, introduced the first one, tackling an enzyme that helps the virus progress inside human cells. In 1995 Hoffmann-La Roche, a Swiss drug firm, launched the first protease inhibitor, which interrupts the virus at a later stage of replication. Today different medicines are combined to suppress resistance or reduce side effects. The rise of combination therapy has brought a flurry of cross-licensing, as companies strike deals to sell each other's drugs in carefully calibrated cocktails.
One company stands out: Gilead. A late entrant to the HIV race, the California firm quickly took the lead. Its strategy was simple: The more convenient the treatment, the better. In 2004 Gilead launched Truvada, a once-a-day, one-pill combination of two drugs. In 2006 it introduced Atripla, a once-a-day, one-pill combination of Truvada and another treatment. Atripla's average wholesale price in America is nearly $25,000 per patient, per year. In 2011 its global sales reached $3.2 billion.
More than 60 percent of HIV drugs in America are bought with public money and patients are rarely pressed to buy the cheapest pills, as they might be if they had another disease. Distributing drugs in poor countries is harder. A decade ago hardly any poor people could afford them. At first drug companies handled this badly. In 1998, 39 big Western firms sued South Africa to protect their HIV patents. Global uproar ensued, and the firms backed down in 2001. Then two things changed.
First, rich countries started donating vast sums to fight AIDS in poor ones. In 2000 there was less than $2 billion for HIV programs each year. By 2010 there was $15 billion. Second, the price of AIDS drugs plunged. In May 2000, a year's "triple cocktail" therapy cost $10,000 or so. By 2011 the same pills sold for $62 in poor countries. The Plan for Aids Relief buys generic versions of patented drugs, which may be supplied only to poor countries. Despite the subsidies and the plunge in prices, less than half of those infected with HIV take HIV drugs. Those who do, however, live a long time, and they have to keep taking the pills. There is also a trade-off between more drugs and better ones: Most patients in poor countries get outdated pills, according to Medecins Sans Frontieres.
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