While a handful of Cambodian AIDS patients are scheduled to begin a drug treatment program next month that could prolong their lives, government and NGO officials are taking a sober look at how the complicated drug therapy would be expanded to serve the estimated 200,000 Cambodians now carrying HIV.
A recent agreement between Medecins Sans Frontieres France and the Ministry of Health means that about 10 AIDS patients will start the triple-combination antiretroviral drug therapy under the supervision of doctors at the Preah Bat Norodom Sihanouk Hospital’s AIDS unit, according to Catherine Quillet, chief of mission in Cambodia for MSF France.
The free treatment at Sihanouk Hospital is part of a pilot program, Quillet said.
MSF may add 10 or 20 patients each month, but the main focus will be on determining what Cambodia needs to do to develop its health care system to the point where it can support a larger effort to distribute the drug treatment.
“We are not planning for quantity. We are planning for quality,” Quillet said. “If we don’t have quality, we won’t increase the number of patients.”
For example, there is concern that patients would take the drugs wrongly, causing resistance to develop.
Doctors overseeing the treatment continually vary the dosage and sometimes change the kinds of antiretroviral drugs in order to avoid the development of resistance. Patients who misuse the drugs can pass on a mutant, drug-resistant HIV strain.
There’s also the worry of how Cambodians will react to the large amount of side effects that come with the treatment. Quillet expects some of the selected patients to drop out.
Though patients in the MSF program will receive the treatment free of charge, MSF is paying $350 per year per patient to Cipla, an India-based pharmaceutical company. The Cambodian government will be able to buy the drugs from Cipla for $600 per patient while individuals can buy them for $1,100. The treatment normally costs between $10,000 and $15,000.
Eventually, money saved on cheap drugs would probably have to be spent on training nurses and doctors how to supervise patients taking the treatment. Quillet said MSF will soon send a foreign doctor to France to learn about the therapy.
While a few doctors in Phnom Penh prescribe treatments to Cambodians who can afford the expensive antiretroviral drugs that are sold over-the-counter at a few Phnom Penh pharmacies, no one in Cambodia knows how to properly administer the treatment.
“Any doctor can prescribe,” Quillet said. “And that’s a disaster.” Still, it is too early to teach Cambodian doctors how to use antiretrovirals, she said.
In the near future, government and NGO efforts and resources will remain focused on prevention and education.
“After the MSF pilot program, we will have a better idea of what is needed,” said Geoff Manthey, country program adviser for UNAIDS. “Now, we are all groping in the dark.”
Nuth Sokhom, vice-chairman of the National AIDS Authority, said government ministers, provincial governors and representatives from provincial AIDS committees will soon meet to plan a national protocol on the distribution and supervision of antiretroviral drug treatments. MSF and the government are also discussing the writing of a national protocol.
“Our national budget is very limited,” he said. “We would be dependent on charity from international organizations.”
Cipla announced in February it will make triple-therapy drug “cocktails,” a strict and regular regimen of pill taking, available at cut-rate prices to 10 developing nations, including Cambodia.
The therapy has been available in Western countries for about five years.
Rather than face certain death from AIDS, people in Europe and North America who contract HIV, the virus that causes AIDS, can usually expect to suffer only a chronic medical condition.
Since February, Sandeep Majumdar of Healol Pharmaceuticals Import Export Co Ltd—the exclusive importer of Cipla drugs in Cambodia—has been working to get Cipla’s generic versions of the high-priced drugs registered by the Ministry of Health. Paperwork was quickly approved by the ministry last month, he said.
The drugs, officials stressed, do not cure people of HIV or AIDS. They merely prolong people’s lives, sometimes by just a few years.
(Additional reporting by Ana Nov)
