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For a poor country like Nepal, it becomes too hard to sustain the
Antiretroviral Programs without using this kind of flexibility in global
Things are already taking a panic course after the Nepal
guideline(2011) in accordance with the World Health Organization
guidelines(2009) are phasing out the use of Stavudine(d4T) in combination
therapy. This has lead to increasing substitution of Zidovudine (AZT) with
Tenofovir(TDF) which the author points increases the cost by 3-folds.
But the substitution program as directed by the National Center for
AIDS and STD Control applies only for the "new cases" who develop serious
toxicities from AZT (reason being limited amount of stocks of TDF) . The
ones already on d4T are continued. The patient's comfort here seems to be
compromised due to the mitochondrial toxicity it induces leading to
neuropathy,Lipoatrophy and lipodystrophy.
As such, the patients on d4T as part of their combination therapy are
forced to adjust their lifestyle to their Antiretroviral medication rather
than adjusting the medication to their daily life. In such scenario the
issue of adherence can always be questioned.
The answer seems preety clear.
"Poor countries must use flexibility in global trade agreement to
improve access to Antiretrovirals"
No competing interests
22 March 2011
Sukraraj Tropical and Infectious Disease Hospital,Kathmandu