24 January 2019 | Statements

Nine quick facts about Unitaid’s investment in advanced HIV

Q&A

People with advanced HIV disease have a very weakened immune system, putting them at high risk of deadly opportunistic infections such as tuberculosis (TB), cryptococcal meningitis, pneumocystis pneumonia and other bacterial and parasitic diseases. HIV destroys essential immune system cells (CD4) that protect the body from infections. Hence, the World Health Organization (WHO) defines advanced HIV disease as having a CD4 count below 200 cells/microliter or WHO clinical stage 3 or 4 of the disease. 

In lower-income countries, one in three people starting treatment have a very weakened immune system and are at risk of death even after getting on antiretrovirals, the medicines used to suppress the HIV virus. In sub-Saharan Africa, about 10 percent of those patients die within the first three months of enrollment. 

Advanced HIV disease prevails —despite the increase in access to antiretroviral treatment (ART)— due to delays in starting ART, treatment interruptions, and development of resistance to antiretrovirals. 

The persistent and high burden of patients with advanced HIV disease leads to deaths from infections that are preventable and treatable; multiplies the costs to health systems; and increases the risk of transmission. Despite the massive scale-up of ART, decline in HIV mortality has plateaued in the last two years at around 1 million annual deaths.

There are now new medicines and screening tools to prevent, diagnose and treat advanced HIV disease, but demand- and supply-side challenges are stopping these products from reaching everyone who needs them.

Unitaid is investing US$ 20 million in measures to avert hundreds of thousands of preventable deaths among people living with HIV. Specifically, it intends to widen access to a package of live-saving medicines and diagnostics for opportunistic diseases in patients with advanced HIV disease. The grant, to be implemented by the Clinton Health Access Initiative (CHAI), builds on Unitaid’s work to expand access to the best available antiretrovirals and foster prompter treatment of HIV. 

Unitaid’s catalytic investment intends to make the WHO-recommended package of health products more affordable and accessible, and pave the way for governments and partners to make it widely available in countries. To that end, the grant will address bottlenecks on both the demand and supply-side of the market (e.g., high prices, low demand, regulatory obstacles). The ultimate goal is to avert hundreds of thousands of preventable deaths and improve the global response to HIV.

Unitaid will target a package of WHO-recommended drugs and diagnostic tools for the management of advanced HIV disease, particularly TB, cryptococcal meningitis and severe bacterial infections. TB and cryptococcal meningitis account for half of HIV-related deaths. TB, the leading cause of death among people living with HIV, killed some 300,000 people in 2017, 86 percent of them in Africa. Cryptococcal meningitis, a fungal infection of the lining of the brain and spinal cord, takes 180,000 lives of people with HIV every year. 

Lead grantee CHAI will partner with Doctors Without Borders (MSF) and the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) in key countries, and both Unitaid and CHAI will continue working with civil society, academia, governments, WHO and global health partners towards the elimination of HIV worldwide. 

In related work last year, Unitaid struck two landmark agreements to improve treatment for those with advanced HIV disease: A deal with Indian drug manufacturer Cipla Ltd. lowered the price of the only combination pill aimed at preventing TB and other opportunistic infections; and another deal with Gilead Science reduced the price of a more tolerable formulation of a drug to treat cryptococcal meningitis.

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