The Parliament of Kenya allows the purchase of cheap AIDS drugs
NAIROBI, June 12 (AFP) - 18h51
The Kenyan Parliament adopted on Tuesday a bill allowing the govern-
ment to circumvent the patents of the pharmaceutical companies to
provide cheaper AIDS drugs to the 2.2 million persons carrying the
virus [in Kenya].
Kenya becomes the second country in Africa after South Africa to
authorise in its legislation the recourse to generic copies of drug
products still under patent.
The Kenyan law presented by the government and supported by the oppo-
sition, was adopted by an unanimous acclamation of the deputies pre-
sent after two hours of debate, noted a journalist of the AFP [Agence
After this vote, technical aspects will have to be re-examined by
parliamentary committees, then it will be represented for a final
AIDS, which affects 2.2 million Kenyans, that is 14 % of the adult
population according to official statistics, was declared a "national
urgency" by the Kenyan president Daniel arap Moi in 1999.
The project, which aims at putting Kenya in conformity with the pro-
visions of the World Health Organisation (WHO), allows the govern-
ment, in the event of a "national catastrophe", to seek drugs less
expensive than those proposed by the companies holders of patents.
It endorses several provisions of the agreements on the intellectual
property related to trade (TRIPS), in particular [Note: numbering
added for clarity]:
[i] the parallel import which makes it possible for a country to buy
a patented product in a country where it is sold cheaper [than] by
the holder of the patent,
[ii] the compulsory licensing which allows to manufacture or to im-
port some generic copies of drugs, and
[iii] "the Bolar exception" which allows a local company to prepare
the marketing of a generic product several years before the expire of
a patent, in order to be ready to put it on the market as soon as
The cost of the anti-retroviral drugs (ARV), which makes it possible
to slow down the development of the disease and to improve the dura-
tion and quality of life of the patients, "is beyond the ordinary
possibilities of Kenyans", indicated the Minister for Health Sam On-
The combination of three drugs commonly used, costs between 2.5 and 5
dollars per day, whereas the average income of Kenyans does not ex-
ceed a dollar per day, he declared. "If the government wanted to as-
sume the cost of it, that would total to 12 billion shillings (173
million US dollars), whereas the total budget of the ministry for
Health is only 9 billion shillings", he added.
"The law such as it is presented is in conformity with the interna-
tional practices and in agreement with the WTO", ensured the Minister
of Industry Nicholas Biwott to the deputies. "The earlier it will be
adopted, the better that will be for the people who suffer from
39 pharmaceutical companies had taken the South-African government to
court, because of a South-African law going back to 1998 allowing the
importation of generic drugs, but they recently gave up their law-
suit following a campaign carried out by NGOs and groups of AIDS pa-
tients [Note: among others the TAC present in court,
Several opposition deputies, while supporting the bill, asked that
the government ensures itself of the quality of the imported drugs
and develops the training of the doctors and the capacities of caring
for the patients, particularly in order to avoid developing resis-
tances to the drugs with badly managed or badly controlled processing
[Note: see below a note reproduced from AF-AIDS on a related issue].
An Nairobi orphanage began on Tuesday to distribute, for the first
time, a generic anti-retroviral drug given by Brazil to Kenyan chil-
dren carrying the virus of the AIDS.
[reproduced with thanks to Carinne Bruneton of E-MED, and translated
under 'fair use' by C. Labadie
RE: Implications of the New Global AIDS Fund - Treatment Issues
[reproduced with thanks from AF-AIDS]
In posting 1069, [...] writes:
It seems that the treatments available for those with AIDS are very
complicated, expensive and have side effects that many cannot manage.
Providing these medicines at a lower cost to Africa sounds good but
the health care systems do not have the capacity to manage such pro-
grams. (end snip)
R. Jeffries replies:
If the author wishes to make a judgement about the value of antiret-
roviral treatment in Africa (and it appears that he does for some
reason), I strongly suggest that he make an effort to find out what
treatment *really* involves as opposed to what it "seems" to involve.
First line regimes now involve as few as 1-3 pills taken morning and
night (twice daily) and can provide prolonged health benefits even if
not used continuously. For example, a recent study (below) shows that
an antiretroviral treatment-related increase in T-cell counts to over
600 takes an average of *two years* to decline to less than 250 (the
danger zone for infections) *after* treatment is stopped. Dr. Paul
Farmer, who has for some time been running a treatment program in
Haiti, has seen responses wherein previously hospitalized mothers
have been able to return to work and begin caring for their kids
again - this echoes the experiences in the US showing that antiretro-
viral treatment does a good deal more than prolong illness.
The most complicated regimens being used in the US are almost exclu-
sively for people with a long history of antiretroviral treatment and
resistance to many of the drugs. In places like Haiti and Africa
where virtually no antiretrovirals have been available, this type of
treatment history does not exist. This likely explains Paul Farmer's
observation that the success rate for antiretroviral treatment in his
Haiti program is higher than reported for clinics in the US.
In conclusion: - The assumption that antiretroviral treatment cannot
lead to a return to health is incorrect - The oft-repeated assumption
that antiretroviral treatment has to be taken "for life" to produce a
return to health is incorrect (although larger studies are needed to
show the minimum amount of therapy that produces the maximum benefit,
and it's scandalous that these studies have not been conducted since
the rationale for this approach has been clear for years - unfortu-
nately, pulsed treatment = less pharmaceutical industry profit and
hence the studies have not been done) - The assumption that all anti-
retroviral treatments are complex is incorrect
[Source:] 8th Conference on Retroviruses and Opportunistic Infections
355 -- CD4 Decay after Discontinuation of Virologically Successful
P .Tebas*(1), K. Henry(2), K. Mondy(1), S. Deeks(3), J. Barbour(3),
C. Cohen(4), and W. Powderly(1).
(1) Washington Univ. Sch. of Med., St. Louis, MO;
(2) Regions Hosp., St. Paul, MN;
(3) Univ. of California, San Francisco; and Harvard Med. Sch., Bos-
CD4-driven "pulse" therapy (initiation and discontinuation of anti-
retroviral therapy at specific CD4+cell thresholds) has been proposed
as an alternative strategy to the current virologically driven para-
digm of HIV treatment. There is little available data about rate of
decline of CD4 cells after discontinuation of therapy in patients who
stop therapy with an undetectable viral load.
We looked at the rate of decay of the CD4 cell count in patients who
discontinued antiretroviral therapy for at least 20 weeks after being
fully suppressed with potent antiretroviral therapy, in two clinical
31 subjects were identified (43% males, 40% white, 32+2 yr of age).
The most frequent reasons for discontinuation of therapy were patient
preference in 56% (most frequently in females in the post-partum),
and drug toxicity (43%). The median nadir CD4 (before therapy) was
383 cells/mm3 (interquartile range, IQR 244 588) and the baseline VL
was 29,845 HIV RNA copies/ml. Patients gained on therapy an average
202+32 CD4 cells. The median time with an undetectable VL before
stopping therapy was 19 weeks (IQR, 9 38 weeks). The median CD4 cell
count at stop was 635 cells/mm3(IQR 355 832). The mean follow-up af-
ter discontinuation of therapy was 50 weeks (range 20 to 119 weeks).
Mean CD4 decay was 16+4 cells/month. The slope of the CD4 decay in-
versely correlated with the magnitude of change of CD4 on therapy (r
= -0.527, p = 0.008) but did not correlate with nadir CD4 cell count,
baseline viral load, type of potent antiretroviral regimen (PI based
vs others), CD4 at the time of stop or gender. No patient developed
an AIDS-defining event during follow-up. Two patients restarted ther-
apy and reached an undetectable viral load again.
In this retrospective cohort of patients, discontinuation of therapy
while fully suppressed was clinically safe. The predicted average
time to reach a CD4 count of 250 cells/mm3in our cohort is 24 months
(95% CI 18 30 months). Patients who gained more CD4 cells on therapy
tended to lose them faster. Pulse therapy strategies deserve further
evaluation in the setting of prospective clinical trials.
Send mail for the `AFRO-NETS' conference to `<firstname.lastname@example.org>'.
Mail administrative requests to `<email@example.com>'.
For additional assistance, send mail to: `<firstname.lastname@example.org>'.