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Demand for ARVs in low and middle income countries

Demand for ARVs in low and middle income countries . Juan Pablo Gutierrez National Institute of Public Health. Basic data. Number of people under ARV treatment Distribution by first line and other regimens Drugs share by regimen. Assumptions. People under treatment (UNAIDS estimations)

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Demand for ARVs in low and middle income countries

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  1. Demand for ARVs in low and middle income countries Juan Pablo Gutierrez National Institute of Public Health

  2. Basic data • Number of people under ARV treatment • Distribution by first line and other regimens • Drugs share by regimen

  3. Assumptions • People under treatment (UNAIDS estimations) • High scenario, total 9.8 million by 2010 (8.3 adults) • Low scenario, total 4.4 million by 2010 • First / second line • 3% failure after 1 year, and 40% yearly increase (i.e. 4.2% after 2 yrs) • Drugs distribution from experts survey • Percent of people under each regimen receiving each drug

  4. Failure rate 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Yr 0 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

  5. Tons of API • Number of patients years receiving a drug • Daily dose by 365 days

  6. Guidelines: use of ARV in dosages per day • Recommended Treatment regimens in adults and adolescents: • First line: ARV – API Dose (mg) ARV Regimens Stavudine (d4T) 80 1. dT4/ 3TC/ NVP Zidovudine (ZDV) 600 2. DZV/ 3TC/ NVP Lamivudine (3TC) 300 3. D4T/ 3TC/ EFV Nevirapine (NVP) 400 4. ZDV/ 3TC/ EFV Efavirenz (EFV) 600

  7. Guidelines: use of ARV in dosages per day • Second line: ARV – API Dose (mg) Abacavir (ABC) 600 Didanosine (DDI) 800 Indinavir (IDV) 800 Lopinavir + Ritonavir (LPV/r) 400 Tenofovir (TDF) 300 Emtracitabine (FTC) 200 Nelfinavir (NFV) 2,500 Ritonavir bust (RTV) 200 Saquinavir (SQV) 2,000

  8. Preliminary Results

  9. First line vs other regimens • 2006: 6.59 to 1 • By 2010: 9.86 to 1 • Increase in coverage faster than switching rate • First line (other) adults patients by 2010 • High: 7.6 million (0.8 million) • Low: 3.4 million (0.4 million)

  10. People by ARV (2010) 6,000 ´000 5,000 4,000 High 3,000 Low 2,000 1,000 0 indinavir (IDV) abacavir (ABC) tenofovir (TDF) efavirenz (EFV) stavudine (d4T) nelfinavir (NFV) didanosine (DDI) lamivudine (3TC) nevirapine (NVP) saquinavir (SQV) zidovudine (ZDV) ritonavir bust (RTV) emtracitabine (FTC) lopinavir + ritonavir (LPV/r)

  11. Tons of API (2010)

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