Tough Choices: Tenofovir, Tenders and Treatment (Opinion‪)‬

Scaling up of antiretroviral therapy (ART) in developing countries would not have been possible without market competition, which has driven down the price of standard first-line antiretroviral (ARV) drugs from more than US$12 000 per person/year in 2000 to US$99 today. However, access to newer, second-line ARVs remains largely restricted to originator (patented) drugs. This causes significant challenges in countries where access to newer medicines is becoming increasingly important as programmes mature and face challenges related to drug toxicity and resistance. (1) Toxicity in particular has emerged as a major reason for individual drug switches and regimen changes, and is strongly implicated in decreasing adherence. This article focuses on international efforts to reduce the price of tenofovir, and outlines the implications of these dynamics for South Africa.