Dr. Jack Preger Mbe - "The Pavement Doctor" Speaks Out About The Deadly Plight Of Those Resistant To First-Line Antiretrovirals In Kolkata, India. Help Is Urgently Needed

Many Indian HIV-positive patients resistant to first-line treatment are not able to be treated by the charity Calcutta Rescue, due to import taxes and an unprocessed registration - which would allow the drugs in free. End Quote

(1888PressRelease) October 04, 2007 - The US based AIDS Healthcare Foundation has called for an investigation by the Indian Monopolies and Restrictive Trade Practices Commission into the marketing by the manufacturers Cipla of the anti-HIV drug Viraday, used for patients who have failed on first-line treatment, due to the virus mutating.

The Government of India collects a tax on this drug from Indian patients equal to US$ 4.40 per month. The Maximum Retail Price (MRP) of this drug in India is US$ 109.75 for 30 tablets, which is one month's treatment. And in addition, the patients pays 4% of the MRP as tax, bringing the cost per month to US$ 114.15. Anyone in India's lower classes who earns as total monthly income US$ 100 is doing well. The My first question is: why does the GOI collect this tax on a drug whose MRP is already beyond the reach of most of the patients who need this second-line drug? Surely, second-line antiretroviral (ART) should be exempt from tax? These patients have failed on the first-line therapy supplied free by National AIDS Control Organisation (NACO).

The NGO I work for (Calcutta Rescue) tries to supply free second-line ART to HIV+ patients, but our funds are nearing exhaustion. I have to state that Cipla supplies me with Viraday at a reduced price of US$ 73.83 for 30 tablets, but I have to pay 4% tax on MRP to GOI, for the privilege of being permitted to supply the drug free to our patients. Cipla also allows me substantial discounts on all the other ART I purchase from them, all for free distribution. On all these purchases I pay 4% tax, not on the discounted price, but on the MRP.

My second question is: why will the Director, Ministry of Social Justice and Empowerment , Government of India , not register Calcutta Rescue under the Indo-US Bilateral Agreement 1968? We have applied twice for an application form and no reply or form has been received since last year. After the form has been submitted, at least six months must elapse before a decision may be expected. We have since last year had a US organisation prepared to supply us with free ART, but we cannot bring the drugs into India because of the Custom duties. The Bilateral Agreement would enable us to accept the drugs free of duty.

Each week now I refuse treatment, due to lack of funds, to new patients who have failed on the first-line drugs supplied by NACO via Government Hospitals. And I have no idea how to finance future supplies of second-line ART to the 54 patients in the care of Calcutta Rescue. No second-line ART is available from NACO.

In the same way, no second-line anti-tuberculosis drugs are available under the DOTS programme for patients suffering from Multi-drug Resistant (MDR) TB, who have failed on the first-line DOTS drugs. Untreated, each MDR-TB patient may infect 15 new patients with this resistant TB per year.

As far as I know, in West Bengal there is no source of free second-line ART for HIV+ve patients apart from Calcutta Rescue; and patients from neighbouring States also come to us for this treatment. A similar situation prevails with MDR-TB: Calcutta Rescue is the only source of free drugs.

Perhaps the AIDS Healthcare Foundation would consider the above points? There is a great need in India for some re-thinking with regard to HIV/AIDS, particularly with respect to the treatment of resistant cases. And also regarding MDR-TB - which is combined with HIV in some patients, and already developing into Extensively Drug- Resistant TB (XDR-TB)

I will be deeply grateful to anybody able to help with this dire situation.

Jack Preger, 7 Ho Chi Minh Sarani, Kolkata 700071.
tel: +913322829171 Mobile: 9830714431.
http://basilicum122.googlepages.com

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