Malaysia Needs Access To More Generic HIV Drugs

Dr Adeeba Kamarulzaman says Malaysia’s position as an upper-middle-income nation means that the country doesn’t automatically qualify for generic price negotiations.

KUALA LUMPUR, Oct 21 – Improved access to more generic HIV drugs can help Malaysia achieve its target of eliminating HIV/AIDS by 2030 as this cuts costs, gets more people living with HIV (PLHIV) on treatment, and helps improve patient adherence.

Infectious disease physician Prof Dr Adeeba Kamarulzaman, who chairs the Malaysian AIDS Foundation (MAF), said despite the country’s access to generic drug efavirenz for first-line treatment, which has allowed free access to antiretroviral therapy (ART) since 2006, second-line treatment remains expensive, with patients expected to be on treatment for life.

“Unfortunately, when patients fail on that (first-line) treatment, they need to go to second-line treatment, which is more costly, and that’s where MAF steps in. We’ve been doing this for many years.

“More than 2,000 people have benefited from MAF’s medicine scheme and right now, we have about 165 people on it that are costing us RM1.4 million a year to support,” Dr Adeeba said at the Sunway-MAF Red Ribbon Gala 2022 virtual press conference today.

“Now, of course, the important thing is to try and get generics in and we’ve just been able to get generic dolutegravir, which is now the recommended first-line treatment

“We in Malaysia fall into this – it’s good that the country is developing and we’re in the upper middle-income bracket — but that also means that often, when new treatment comes up, we don’t automatically qualify for the kind of generic price negotiations that countries with lower GDP (gross domestic product) and HIV prevalence tend to get. You will soon see this with a newer drug, the long-acting cabotegravir (CAB-LA),” Dr Adeeba said.

CodeBlue previously reported that Malaysia will likely have access to generic versions of CAB-LA, the first injectable medication to prevent HIV, in 2027 at the earliest, along with other “second-tier” countries.

According to data from the Penang Institute in 2017, first-line ART treatment involving various drug combinations, including efavirenz, can cost from RM115.20 to RM450 per month. Second-line ART treatment with a combination of zidovudine, lamivudine, lopinavir or ritonavir can cost up to RM780 per month.

This means that a lifetime treatment on ART of about 50 years can cost between RM69,120 and RM468,000, depending on the level of treatment. The calculation does not include costs for viral load tests, medication for other comorbidities, and consultation or hospital fees.

“The lower we can get the cost down, the better. Because with ARV, until we find a cure, we have to treat people for life, so it contributes to a big sum in the annual budget,” Dr Adeeba said.

The Sunway-MAF Red Ribbon Gala 2022, which takes place on October 28 this year at the Sunway Resort Hotel, is aiming to raise up to RM2.5 million amid disruptions to HIV treatment efforts due to the Covid-19 pandemic. 

Proceeds raised will benefit MAF’s medicine assistance scheme. The scheme, which is officially recognised by the Ministry of Health (MOH) for its pivotal role in bridging the gap in Malaysia’s ARV treatment, provides subsidies for second-line ARV medicine to low-income patients in Malaysia who are not yet covered by the national health care budget.

With the price of second-line ARV ranging from RM500 to RM2,000 per month, the programme provides a new lease of life for many Malaysians from low-income backgrounds living with HIV. 

Only about 58 per cent of PLHIV in Malaysia are receiving ARV treatment, according to the MOH’s Global AIDS Monitoring 2021 Progress Report.

The gala will be graced by the presence of Perak’s Sultan Nazrin Muizzuddin Shah and Raja Permaisuri Perak, Tuanku Zara Salim. The theme for the black-tie affair is ‘Sustainability’.

“We hope our supporters and local corporate citizens will continue to support the Red Ribbon Gala project which will help us to bridge this gap in treatment and ensure that these life-saving medicines reach as many Malaysians living with HIV as possible,” said Dr Adeeba.

Sunway Group founder and chairman Jeffrey Cheah said the group is proud to be a long-term partner of MAF, and its support for the cause is based on Sunway’s corporate social responsibility (CSR) commitment to leave no one behind.

“This is why most of our CSR projects are focused on helping the marginalised and often forgotten sectors of society.

“If our country is to live up to its claims of being a caring society, it is essential that we help our fellow Malaysians who are struggling to survive in a world of darkness and misery.

“Our belief that no one should be left behind is one of the fundamental reasons why Sunway is deeply committed towards advancing the sustainable development agenda.

“Building a sustainable future requires the commitment of all elements of society – the government, private sector, academia, civil society, and, of course, every single individual. We are all in this together,” Cheah said in a statement.

Jessy Lai, chair of the World Conference on Exercise Medicine and CEO of Monspace Multinational Companies, who is the Gala’s co-sponsor said: “We are truly excited that the Gala is making a return this year. While some may see it as a glamorous event, we should remind ourselves that this charity benefit actually aims to raise funds for poor Malaysians living with HIV to access life-saving medication and treatment.”

“We hope that our contribution will help MAF to reach out to many more people living with HIV who need urgent assistance in their fight for survival and at the same time, keep the momentum to move forward in their mission to end AIDS in the country.”

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