Finally someone commented on this blog by writing to rjw88@hotmail.com.

OK OK so it was my mom commenting on "right plan wrong pills". My mom
Katharine Waldmann MD used to take care of people with HIV as her job. Now that she has retired she does it as a volunteer. She explains to me that the WHO proposes 3 drugs not including protease inhibitors for medical reasons not because they respect patent law (which they appear willing to ignore)

Katharine Waldmann writes

"I was told by a drug rep from the company that makes Viramune that the talk of a three drug pill(zerit, Epivir (lamivudine) and viramune) is based on the plan to buy from India where this is made--patent violation of course.

Protease inhibitors are very potent but besides expense they have problematic side effects--diabetes, lipodystrophy, high blood lipids. They are big capsules to take (not hydrophilic so large doses needed to get enough absorbed)and usually need to take many a day: Viracept ten a day (just started making tabs where one neede to take only two twice a day), Fortovase six or eight twice a day.
What helps is that ritonavir (Norvir) interferes with the metablism of most of the others, so 100 mg of ritonavir makes it possible to reduce the number of other capsules and has enabled shifting from three times a day dosing and meal restrictions. Kaletra is a capsule with ritonavir plus lopinavir in one capsule.

There has been a big push to avoid protease inhibitors as first line treatment. Trizivir has three NRT's but usually a fourth has to be added. Efavirenz (Sustiva) is very effective and a once a day program is possible--Sustiva 600 mg, Epivir 300 mg, and Viread 300 mg.

Capsules don't keep well in heat and humidity. So I don't think it is only or even mainly the cost of PI's, but some of these other issues.

Your Blog is very interesting!! keep it up MOM "


Well, at leas my mom likes my blog.