For about $75, the governments in South Africa and Kenya will soon be able to treat an HIV-infected person for 1 year with a pill taken once a day that contains a “best-in-class” combination of three antiretroviral (ARV) drugs.
The backbone of the new pill is dolutegravir, a remarkably powerful and safe ARV that inhibits HIV’s integrase enzyme and has been too expensive for most poor and middle-income countries to afford. The annual per-person cost of the new pill, made by generic manufacturers, is also about $25 less than the least expensive similar triple-ARV combo pill on the market. “This is a major breakthrough,” says Michel Sidibé, head of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Geneva, Switzerland.
The new pill, will help speed efforts to offer treatment to all 37 million HIV-infected people in the world, Sidibé says. Currently, only 19.5 million are receiving ARVs. The pill will be offered as a first-line treatment, and the hope is that its excellent “profile”—powerful suppression of HIV, low toxicity, and ease of use—will make it simpler for people to stay on treatment for their lifetimes and reduce the chances of ARV resistance emerging. The other two ARVs in the cocktail are lamivudine and tenofovir, both of which are already in widespread use.
South Africa, which has more HIV-infected people than any country and is the biggest purchaser of ARVs, estimates it will save $900 million over 6 years. The pill “will greatly benefit our patients due to its superior therapeutic qualities,” said Aaron Motsoaledi, South Africa's minister of Health in Pretoria, who said the country expects to make the first purchase in April 2018. UNAIDS says the intent is eventually to offer this in 92 countries