BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7049.124 (Published 13 July 1996) Cite this as: BMJ 1996;313:124

The lesson of tuberculosis is that drug resistance may be overcome by treatment with three (or more) drugs. The same seems likely to be true of HIV infection. A trial in 16 AIDS units(Annals of Internal Medicine 1996;124:1019-30) looked at the effect of adding nevirapine or placebo to treatment with zidovudine and didanosine. After 48 weeks the patients assigned to triple treatment had 18% higher CD4 counts and lower titres of HIV. A severe rash was more common in the patients taking nevirapine.

None of the world's eight largest pharmaceutical companies is active in research and development of new contraceptives, says Carl Djerassi in a letter to “Science” (1996;272:1858-9). The market has spoken and is not interested in the unmet needs of the poor countries—any more than it is interested in developing drugs for the four biggest global killers, acute respiratory infections, diarrhoeal diseases, tuberculosis, and malaria.

And the same seems to be true of vaccines against AIDS. The current consensus among market analysts (Science 1996;272:1880) is that HIV vaccines are doomed by market failure, by which is meant that the capitalist incentive is not high enough to meet the public health need. In the US market lawsuits are an …

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