Volume 6 Number 2/3 February/March 2005

The Treatment Alert that forms the first article of this issue of HTB concerns the interactions between atazanavir and omeprazole, but relates to a contraindication against prescribing proton-pump inhibitors or H2-receptor blockers or any acid-reducing agents with some protease inhibitors (atazanavir, fosamprenavir, indinavir).

Our comments to this letter also include references to a study at the Glasgow conference that showed misprescribing was common in some US clinics, despite knowledge of the likely negative interaction when atazanavir was first licensed.

Other reports from the Glasgow Conference include results from randomised clincial studies that show a clear benefit from steroid treatment in HIV, which is an important option that has generally been underused in the UK compared to the US.

Treatment access issues are always covered in HTB. This issue reports the promise of greater access to generic drugs in Africa, but also on a meeting that i-Base helped organise between generic manufacturers in India and community advocates. A brief report from the meeting is included in this issue and a full report will follow.

On one level the obstruction to any level of generic company involvement from research-based pharmaceutical companies has slowly changed. Recent agreements in South Africa, reported in this issue, will now expand access to more affordable treatment in these markets that otherwise held no real financial incentive for Western companies anyway.

On the other hand, the pharmaceutical lobby in the US still heavily influences US trade agreements, which undermine these advances. Recent US pressure has forced many individual countries (India, Thailand, Brazil) to sign new trade agreements that have greater restrictions than required by TRIPS.

This will limit future access to any drugs discovered after 1995 for most people living with HIV in developing countries.

And these less public changes have been initiated with little public awareness or protest.