INVITED SPEAKER

Dose reduction of antiretrovirals: a feasible approach to expand HIV treatment in low and middle income countries?

Prof. Sandro Vento
,

Abstract

Over 35 million people are living with HIV worldwide. Antiretroviral therapy (ART) has been scaled up considerably especially in sub-Saharan Africa, and at present 6.6 million people in low and middle-income countries are receiving HIV treatment. The global economic crisis, the switch in emphasis of donors’ priorities to global health, and the changes in the new WHO recommendations to initiate ART at a threshold of 350 CD4 cells/mm3 will affect the ability of the health systems in developing countries to enrol new patients and to sustain patients on ART in the long term at the current cost of antiretrovirals. Drug costs indeed account for as much as 60% of antiretroviral treatment program costs in several countries, and the production costs of active product ingredient are the greatest driver of generic antiretroviral drug prices.
Dose reduction of different antiretrovirals needs to be urgently explored as one of the possible options to help and sustain ART roll-out in developing countries. Preliminary evidence suggests that stavudine, efavirenz, atazanavir, darunavir, lopinavir/ritonavir could all be used at reduced doses without compromising efficacy. Tenofovir might also be tested at reduced doses. In addition to decreasing costs and eventually allowing a wider access to anti-HIV therapy for populations in need, dose reduction would decrease adverse events, improve tolerability and favour adherence to treatment.
It is urgent to implement reasonably large, well-powered non-inferiority trials comparing lower doses versus the currently used ones.

Biography of the Invited Speaker

Professor Sandro Vento is Head of the Department of Internal Medicine and Acting Head of the School of Medicine, University of Botswana. He is the Editor-in Chief of The Open Infectious Diseases Journal and member of the International Advisory Board of The Lancet Oncology. Professor Vento has authored or co-authored over 160 publications in high impact factor, peer-reviewed medical journals. His research interests are in the areas of HIV infection, viral hepatitis, infections in patients with cancer, antibiotic therapy and autoimmune liver diseases.