1. Generics – what can be done
Dr Andrew Hill
Department of Pharmacology and Therapeutics
University of Liverpool
United Kingdom
IAS Paris, Wednesday 26th Julu 2017

2. ART Coverage by country, 2016 19
ART Coverage by country, million on ART, but funding cuts on the way

3. Global ART treatment demand will rise by 800,000 per year, unless HIV infection rates fall
1.8 million
new HIV
infections*
/year
Need for ART ( ):
30 million in 2017
32.4 million in 2020
36.4 million in 2025
1 million
HIV-related
deaths*/year
*REF:

4. Hepatitis C: net cure rates in 2016, by country 1
Hepatitis C: net cure rates in 2016, by country 1.5 million people cured, 1.6 million new infections
< 1%
1% - 7%
> 7%
Hill et al. J Vir Erad, July 2017, 3:

5. $90 $90 $90: Prices and costs of treating HIV, HBV, HCV and TB
DRUG
USA PRICE
GLOBAL LOWEST PRICE
TARGET
PATENT EXPIRY (US)
HIV: TDF/3TC/EFV
$28,204
$100
$78
Generic
HBV:
TDF/FTC
$17,258
$67
$54
HCV:
SOF+DCV
$142,710
$108
$47
TB:
RHZE
$945
$27
$38
HIV and HBV: price per year. HCV: price per 12-week course, TB: per 6 month course,
Patent expiries from US FDA Orange Book, for solid oral dosage forms only.

6. $200 billion in HIV drug sales

7. Gilead sales and profits
Cumulative sales of Sovaldi & Harvoni until
1Q 2017:
$49 billion
Profits in 2015:
$18 billion
Reference: Gilead quarterly product sales summaries

8. Generics can be cheap worldwide

9. in any country. High quality, WHO approved
Generic TDF/3TC/EFV should also be available for prices close to $90/year,
in any country. High quality, WHO approved
Cipla – Tenvir-EM
Mylan – Revcovir-EM

10. “Throwing the kitchen sink” at HIV
Same day testing and treatment Treating all patients, at any CD4 count “No questions asked” approach to chemsex Regular follow up with text reminders PEP PrEP

11. Reductions in new HIV+ diagnosis per month,
56 Dean Street London, 72 15

12. Conclusions - HIV
The patents on tenofovir, 3TC and efavirenz have expired. The TDF/3TC/EFV tablet should be available in any country for $90 per year, or a similar price
We should then be measuring the value of new drugs like TAF or DTG versus this $90 price.
This new economics could lead to a cascade of price reductions worldwide, and the chance to treat far more people on limited budgets.
The money saved could then be spent on PEP, PrEP and more HIV testing. This could drive down HIV incidence significantly.

13. Conclusions – Hepatitis C
Worldwide, for every person cured of Hepatitis C in 2016, another person was newly infected. We will not reach elimination of HCV at the current price levels A $90 unit price per cure can be achieved. However, we need more donor funding and commitments from national health authorities.