A report released today by the World Health Organization (WHO), UNICEF and UNAIDS paints a slightly encouraging picture of access to antiretroviral therapy (ART) in the world’s poorer countries.

The kind of antiretroviral therapy (ART) that patients receive has been steadily diversifying. Stavudine, which accounted for 67% of first-line treatments in 2006, represented 51.5% of first line treatments by the end of 2009. Zidovudine (AZT), which dipped in usage between 2006 and 2007 but has been on the rise since, accounted for around 40%, and tenofovir (TDF), a little more than 10%.

The WHO has encouraged countries to phase out the use of stavudine, due to irreversible side-effects like numb limbs and fat loss. This has proven difficult for poor countries, since the average annual cost of a course of stavudine in 2009 was $81 per person; for tenofovir, it’s $613.

Costs for first-line ART dipped only very slightly in 2009. The weighted median price of a first-line antiretroviral treatement course was $137 per person per year, a 3% decrease from 2009 and a 54% decrease from 2006. But even though pricing has been steadily declining thanks to favorable pricing schemes from pharmaceutical companies, there’s unlikely to be a sharp drop for these first-line drugs in the near future.

“I think the most important potential decrease in cost is for the second-line regimen,” says Yves Souteyrand, who is the coordinator for strategic information for the WHO’s HIV/AIDS office in Geneva. Currently, the weighted median cost for second-line ART is $853 per person for year.

It should be noted that the numbers in this report were calculated using the WHO’s new guidelines, released this past July, which raised the threshold to initiate ART from 200 cells/mm3 to 350mm3. This meant the number of people who needed HIV treatment at the end of 2009 increased from 10.1 million to 14.7 million.

Overall, the proportion of global coverage using the new guidelines went from 28% to 36% in 2008-2009. Using the old guidelines, that figure would have been 42% to 52%.

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