In September of 2017, it was announced at the seventy-second U.N. General Assembly that the HIV treatment regimen TLD (tenofovir disoproxil fumarate, lamivudine and dolutegravir) has been made more accessible to low and middle income countries. This has been accomplished with a price agreement established through the partnership of various countries and global aid programs.

Some of the groups that collaborated on the new price agreement include UNAIDS, the Clinton Health Access Initiative (CHAI), PEPFAR, USAID, the World Health Organization (WHO), the Bill and Melinda Gates Foundation and the governments of South Africa and Kenya. Teams in many countries have begun developing plans to transition TLD into use by the end of 2019. Over 50 low or middle income countries have already introduced or are planning to introduce TLD as the favored first-line treatment for HIV.

Improvements to TLD

TLD medication is already considered a preferred method of HIV treatment in the United States. However, with the use of a generic treatment and a pricing agreement, TLD is now expected to cost health programs in low to middle income countries covered by the agreement only $75 per person per year once the treatment has been fully transitioned into use.

The newly released TLD is a generic treatment consisting of a single pill taken once a day containing a dolutegravir base. Studies have shown that the TLD regimen has fewer side effects on the patient and also has less vulnerability to the development of drug resistance that would render it ineffective. This helps because it means that fewer people would have to start new levels of treatment. TLD has also been shown to provide a more rapid repression of viral load.

Effects of New HIV Treatment

Three countries that began using the TLD treatment by the end of 2017 include Brazil, Botswana and Kenya. Within three months of treatment, studies show that 81 percent of patients using TLD in Brazil had an undetectable viral load, as compared to another HIV treatment regimen with an EFV (efavirenz) base, which had 61 percent presenting with an undetectable viral load after three months of treatment. Botswana and Kenya have shown similar success, with 90 percent of those using the treatment reaching full viral suppression in 2018.

In 2016, only 53 percent of people infected with the HIV virus were receiving treatment. Under the licensing agreement that sets a maximum price on the dolutegravir-based medication, 92 low to middle income countries will be able to provide the treatment to their citizens. These countries represent 90 percent of the people living with HIV in low to middle income countries. The TLD pricing agreement will not only be able to reduce the cost of treatment for the people in these countries but will increase availability so that more people can be treated.

A Brighter, Healthier Future

The launch of this new TLD treatment is another step forward in the treatment of people suffering globally from HIV and AIDS. People who did not originally have access to the dolutegravir treatment due to cost and availability will now be able to use this treatment. TLD provides a more reliable treatment regimen that will improve many people’s lives and ultimately bring the world a little further in the fight against HIV.

– Lindabeth Doby
Photo: Flickr