1. Forecasting for ARVs medicines
Baseline Estimates
November 2005

2. Methods
Volumes of the currently sales of ARVs were collected from AMDS partner organizations ,and grouped in 3 groups:
Low Income countries
Middle Income countries
Brazil

3. Calculation of the number of patients from procurement data
1) Number of smallest pharmaceutical units procured was converted in number of patient-years of drugs used
2) Percentage of individual drugs used was expressed against the total volume of API procured (expressed in patient-years)
3) Drugs were deemed to be used as first line and second line drugs when recommended as such for the majority of patients according to the 2003 WHO ART guidelines.

4. WHO recommendations for first and second line drugs
First line ARVs
NRTI
stavudine (d4T), zidovudine (ZDV), lamivudine (3TC)
NNRTI
nevirapine (NVP), efavirenz (EFV)
Second Line
NRTI /NtRTI
Tenofovir (TDF), abacavir (ABC), didanosine (ddI), PI
lopinavir (LPV), ritonavir (r), saquinavir (SQV) , indinavir (IDV),
nelfinavir (NFV), atazanavir (ATV).

5. Middle Income countries
Volume de ARV transactions reported in GPRM
between January 1,2005 and July 31,2005 (in patient-years)
First line
Low Income countries
Middle Income countries
Zidovudine (ZDV) 5%
Stavudine (d4T)
25%
27%
Lamivudine (3TC)
31%
30%
Nevirapine (NVP)
28%
26%
Efavirenz (EFV) 7% 8%

6. Middle Income countries
Volume de ARV transactions reported in GPRM
between January 1,2005 and July 31,2005 (in patient-years)
Second Line
Low Income countries
Middle Income countries
Abacavir(ABC)
0,2%
Tenofovir (TDF)
1,0%
0,0%
Emtricitabine(FTC)
0,4%
Didanosine (ddI)
0,3%
0,9%
Indinavir (IDV)
0,5%
0,8%
Lopinavir + ritonavir (LPV/r)
0,1%
Nelfinavir (NFV)
Saquinavir(SQV)
Ritonavir (boost)
0,7%
0,6%

7. Middle Income countries
Volume de ARV transactions reported in GPRM
between January 1, 2005 and July 31,2005(in patient-years)
Low Income countries
Middle Income countries
Total volume of API patients/year
321,770
83,450
Number of patients years of triple therapy (approximation)
106,500
27,800

8. Volume of ARV transacted in Brazil January 1 to December 31,
In 2004 patient-years 
BRAZIL
First line
% of total volume of patients/years
Zidovudine (ZDV)
22%
Stavudine (d4T) 8%
Lamivudine (3TC)
28%
Nevirapine (NVP) 4%
Efavirenz (EFV)
12%

9. % of total volume of patients/years
Volume of ARV transacted in Brazil January 1 to December 31,
In 2004 patient-years 
BRAZIL
Second line
% of total volume of patients/years
Abacavir(ABC)
0,5%
Tenofovir (TDF)
0,8%
Emtricitabine (FTC)
0,0%
Didanosine (ddI)
5,0%
Indinavir (IDV)
2,0%
Lopinavir + ritonavir (LPV/r)
4,0%
Nelfinavir (NFV)
Saquinavir(SQV)
Atazanavir (ATV)
1,0%
Amprenavir (APV)
0,2%
Ritonavir - Boost (r)
8,0%

10. Brazil 487,307 156,300 Volume of ARV transacted in Brazil
January 1,2004 to December 31, 2004 (in patient-years)
Brazil
Total volume of API patients/year
487,307
Number of patients years of triple therapy (approximation)
156,300

11. A glimpse of the future:
Likely orientation of the 2006 WHO ART guidelines
Comparison of 1st and 2nd Line ARV Drug Formularies for Adults and Adolescents (2003 vs 2006)

12. d4T*or ZDV EFV 3TC or FTC NVP ABC or TDF A glimpse of the future:
Likely orientation of the 2006 WHO ART guidelines
Comparison of 1st and 2nd Line ARV Drug Formularies for Adults and Adolescents (2003 vs 2006)
d4T*or ZDV
Triple NRTI alternative
EFV
3TC or FTC
NVP
ABC or TDF
Classical NRTI/NNRTI approach