Soaring antiretroviral prices, TRIPS and TRIPS flexibilities: a burning issue for antiretroviral treatment scale-up in developing countries

Purpose of review The achievement of significant reductions in the price of antiretroviral drugs constitutes one of the main economic pillars of antiretroviral treatment scale-up in developing countries. Today this economic pillar is threatened. Recent findings The prohibitive prices of newer first-line and second-line regimens have created a watershed in relation to the prices of earlier first-line treatments. These price increases are closely related to the World Trade Organization's Agreement on the trade-related aspects of intellectual property rights (TRIPS) that imposes an important barrier to generic competition. Intellectual property flexibilities foreseen by the TRIPS agreement allow the manufacture and supply of affordable generic versions of new generations of antiretroviral under certain conditions. However, the capacity to supply a specified list of generics under such conditions is tight and the utilization of such flexibilities in their current form remains complex and unattractive. Summary The TRIPS agreement currently constitutes a significant barrier to providing access to new antiretroviral at affordable prices in developing countries. If the debate on initiatives for increased flexibility of intellectual property rights does not become more extensive or obtain the overwhelming support of the international community, serious consequences are to be expected in terms of the fight against AIDS in most of the developing countries.