Opportunistic Infections

Tuesday, May 24, 2005

Price of key drug slashed in face of TAC pressure (Amphofericin B)

By Emily Goligoski

A medication described as the most effective in treating a type of meningitis that can be fatal for people with HIV/Aids is soon to be available for a sixth of its price today.

From July 1, Bristol-Myers Squibb's drug Amphofericin B is to be priced at R22.60 for a vial instead of between R145 and R190, before VAT. It is used to treat cryptococcal meningitis, an opportunistic infection that is virulent in people with HIV/Aids.

The Treatment Action Campaign (TAC) has been working since February to get the cost of the drug, marketed as Fungizone, reduced after complaining that it is priced excessively in South Africa.The campaign was a combined effort with the Southern African HIV Clinicians Society, the Desmond Tutu HIV Centre and the Aids Law Project, which threatened to bring legal action against Bristol-Myers Squibb unless the price was cut.

"The price reduction was relatively quick and it made sense for (the company) to act right away because of the extent of blatant overpricing," said TAC spokesman Nathan Geffen.

Company general manager Michael Barry said the drug was produced at overseas plants at different costs.

The company has been talking to the Medicines Control Council (MCC) and the TAC since March and is awaiting the MCC's approval for sourcing and price changes.

Barry said the company was reducing the price because it was committed to expanding drug access to HIV/Aids patients who need it most.

Tihana Bicanic, a specialist in infectious diseases at the GF Jooste Hospital in Manenberg, said there was no data on the South African incidence of cryptococcal meningitis, but 13% to 44% of patients died. Even with optimum treatment, in the US up to 25% of people died.

Bicanic said Amphofericin B killed harmful organisms faster than another drug on the market. It is the first choice for hospitals that can give it. It required intravenous injection and in-patient treatment for seven days. Bicanic emphasised that, if the drug was to be effective, hospitals needed facilities to administer it.

(Published on the web by Cape Times on May 24, 2005)

Friday, May 06, 2005

Cochrane Review: Cotrimoxazole prophylaxis for opportunistic infections in adults with HIV

Grimwade K, Swingler, G.


[A substantive amendment to this systematic review was last made on 25 March 2003. Cochrane reviews are regularly checked and updated if necessary.]


The prevention and early treatment of infections are the mainstay of the medical management of the majority of people with HIV infection, who live in low income countries without access to antiretroviral drugs. Cotrimoxazole is cheap and effective against a wide range of organisms. However, routine prophylactic treatment is difficult to deliver in low-resource settings, and could also lead to increased resistance to the drug.


To assess the effects of routinely administered cotrimoxazole on death and illness episodes in HIV infected adults.

Search strategy

We searched the Cochrane HIV/AIDS Group register, the Cochrane Controlled Trials Register, MEDLINE, LILACS, AIDSLINE, AIDSTRIALS and AIDSDRUGS databases, and proceedings and abstracts from AIDS and tuberculosis (TB) conferences (search date July 2001). We checked reference lists for trials and other pertinent articles, and contacted pharmaceutical companies and experts in the field.

Selection criteria

Randomised or quasi randomised trials comparing routinely administered cotrimoxazole versus placebo or no treatment in adults (age greater than 13 years).

Data collection and analysis

Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear trial authors were contacted for further details.

Main results

Four trials involving 1476 people were identified. Three trials (1416 people) studied heterosexual men and women in West Africa. A fourth trial was of homosexual men on chemotherapy for Kaposi's sarcoma, in the United States. Meta-analysis of the three African trials showed a significant beneficial effect of cotrimoxazole for death: relative risk 0.69 (95% confidence interval 0.55 to 0.87); for morbid events: 0.76 (0.64 to 0.9); and for hospitalisation: 0.66 (0.48 to 0.92). There was no significantly greater risk of adverse effects: relative risk 1.28 (0.47 to 3.51). Effects were similar in people with early and advanced HIV disease. Insufficient evidence was found on effects in areas with higher bacterial resistance or in people on antiretroviral therapy.

Authors' conclusions

In the trials included in the review, cotrimoxazole prophylaxis had a beneficial effect in preventing death and illness episodes in adults with both early and advanced HIV disease. However, the wider applicability of these findings is unclear, in particular to areas with higher background bacterial resistance to cotrimoxazole. Further trials would be required in differing settings to widen applicability.


Grimwade K, Swingler, G.. Cotrimoxazole prophylaxis for opportunistic infections in adults with HIV. The Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003108. DOI: 10.1002/14651858.CD003108.

[Source file here]