“The United States is on course for some much-needed economic relief from the crippling cost of HIV treatment, with the anticipated arrival of generic versions of guidelines- preferred antiretrovirals. However, much preparation is required to maximize price competition, maintain patient choice, and ensure that savings are used to the advantage of people living with HIV.
With the patent expiration of efavirenz sometime this year, a generic-based regimen comparable to Atripla is on the horizon: efavirenz combined with lamivudine and branded tenofovir (Viread). According to recent mathematical modeling conducted by Rochelle Walensky of Harvard Medical School and colleagues, the U.S. health care system savings associated with this regimen could be up to $560 million in the first year alone; a regimen containing three generics would save up to $920 million.
The study has stirred up a much-needed dialogue on coming generics, but it has also come under criticism for its projection of reduced efficacy using efavirenz/lamivudine/Viread: a switch could shorten life expectancy by 4.4 months. The model based this projection on data showing lamivudine to be not as potent as emtricitabine in Atripla, though a recent analysis by the World Health Organization suggests this is likely unfounded, particularly when powerful agents like efavirenz and tenofovir are used. Another concern is that a switch from a single-tablet regimen to a three-tablet (albeit once-daily) regimen will affect adherence, yet as Médecins Sans Frontières (MSF) and others have noted, there are surprisingly few data to confirm this hypothesis…”
read more at Treatment Action Group