Scaling-up the use of generic antiretrovirals in resource-limited countries: generic drugs for health.

The number of people living with HIV (PLHIV) continues to increase around the world because of the increasing number on antiretroviral therapy (ART) and their associated increase of life expectancy, in addition to the number of people newly infected with HIV each year. Unless a 'cure' can be found for HIV infection, PLHIV can anticipate the need to take antiretroviral drugs (ARVs) for the rest of their lives. Because ARVs are now being used for HIV prevention, as well as for therapeutic purposes, the need for effective, affordable ARVs with few adverse effects will continue to rise. It is important to note that the dramatic growth in treatment coverage of PLHIV seen during the past decade has been primarily due to the increased use of generic ARVs. Thus, there will be a need to scale-up the research and development, production, distribution and access to generic ARVs and ART regimens. However, these processes must occur within national and international regulated free-market economic systems and must deal with increasingly multifaceted patent issues affecting the price while ensuring the quality of the ARVs. National and international regulatory mechanisms will have to evolve, which will affect broader national and international economic and trade issues. Because of the complexity of these issues, the Editors of this Supplement conceived of asking experts in their fields to describe the various steps from relevant research and development, to production of generic ARVs, their delivery to countries and subsequently to PLHIV in low- and middle-income countries. A main objective was to highlight how these steps are interrelated, how the production and delivery of these drugs to PLHIV in resource-limited countries can be made more effective and efficient, and what the lessons are for the production and delivery of a broader set of drugs to people in low- and middle-income countries.

The role of intellectual property rights in treatment access: challenges and solutions.

PURPOSE OF REVIEW: The purpose of this study is to review relevant literature published from January 2011 to July 2012 that specifically addresses the impact of intellectual property protection on access to antiretroviral drugs. RECENT FINDINGS: The articles reviewed discussed the relation of intellectual property protection and access to medicines. For most authors, the World Trade Organization (WTO) Trade-Related Intellectual Property Rights Agreement (TRIPS) and the 10-year anniversary of the 2001 WTO Doha Declaration on TRIPS and Public Health formed an important background for the review of the current state of play. SUMMARY: Intellectual property plays an important role in implementing policies to ensure HIV treatment and care programmes. From the review, three main themes emerged: the implementation of the Doha Declaration, the role of generic competition in antiretroviral treatment scale-up and innovative licensing mechanisms. The attention for the effects of intellectual property on access to HIV medicines opened the path for new initiatives for the management of patents using public health objectives as the key driver such as the UNITAID-backed Medicines Patent Pool. Some of the literature addressed the question whether more fundamental changes in the intellectual property architecture were necessary.

Treatment 2.0: catalyzing the next phase of treatment, care and support.

PURPOSE OF REVIEW: This review provides an update on the WHO/UNAIDS Treatment 2.0 strategy by reviewing the documents and technical updates issued under the initiative. Launched in 2010, this global initiative provides a framework for the continued scale-up of access to HIV care and treatment. RECENT FINDINGS: WHO has prioritized once daily fixed-dose combination as the preferred antiretroviral (ARV) regimen to initiate HIV treatment, paving the way for programmatic simplification, with reduced toxicity and improved adherence. WHO also recommends the use of point-of-care diagnostics, with CD4 cell count technologies being implemented in the field and progress towards improving access to simplified viral load testing. The strategy also seeks mechanisms that can contribute to reducing treatment costs, such as pooled commodity procurement and public health-oriented licensing approaches. Improved service delivery, specifically through decentralization, task shifting, integration and community mobilization also has the potential to reduce costs and improve access. Support to countries has been provided through the timely release of a series of programmatic and technical updates on specific treatment-related topics. SUMMARY: The Treatment 2.0 strategy articulates how innovation and greater efficiency can make HIV care and treatment more accessible and affordable, and guide treatment and prevention scale-up.

Peribulbar anesthesia for blepharoplasty.

BACKGROUND: Peribulbar anesthesia for inferior blepharoplasty was used successfully in 788 selected cases over the past 9 years. This technique is largely accepted for ophthalmologic procedures, but is not yet specifically used for blepharoplasty. METHODS: In the past 9 years, 788 patients ages 36 to 77 years were submitted to inferior peribulbar anesthesia for blepharoplasty procedures. Of these patients, 623 (79%) were women and 165 (21%) were men. The anesthetic procedure is performed using a needle introduced at the junction of the medial two-thirds and the lateral third of the inferior orbital rim (point A). With the patient staring forward, the needle is introduced through the lid at point A. It enters the orbital cavity just above the orbital floor periosteum until the globe equator is minimally trespassed (depth, approximately 31 mm). There, 3 ml of the local anesthetic solution (2% lidocaine + 0.5% bupivacaine) is slowly injected. RESULTS: None of our treated patients reported pain or discomfort during or after the surgical procedure. Immediately after inferior peribulbar anesthesia, chemosis was observed in 17 cases (2.2%) and orbital hematoma in 3 cases (0.4%). Diplopia, or a slight imaging distortion lasting a few hours may occur after inferior peribulbar anesthesia. CONCLUSION: Inferior peribulbar anesthesia for blepharoplasty offers surprising results. The surgical procedures are performed pain free, leaving the patients completely relaxed and allowing an easier surgical procedure. This technique should be performed only by highly skilled anesthesiologists or surgeons with a perfect knowledge of the complex orbital anatomy.

A utilização da anestesia peribulbar inferior nas blefaroplastias / The inferior peribulbar anesthesia for blepharoplasties

Introdução: A anestesia peribulbar para blefaroplastias inferiores foi utilizada com sucessoem pacientes selecionados nos últimos 9 anos. Esta técnica é amplamente utilizada nosprocedimentos oftalmológicos, porém ainda não havia sido especificamente indicada paraas blefaroplastias. Métodos: Foram submetidos a blefaroplastias com bloqueio peribulbarinferior 788 pacientes com idade variando entre 36 e 77 anos, 623 (79%) eram mulheres e165 (21%) homens. Resultados: Nenhum dos pacientes tratados queixou-se de dor ou desconfortodurante ou após a cirurgia. Quemose imediata (17 casos - 2,2%) após a anestesiaperibulbar inferior, hematoma orbital (3 casos - 0,4%) e diplopia foram as complicaçõesobservadas. Conclusões: A anestesia peribulbar inferior para as blefaroplastias ofereceresultados surpreendentes. As cirurgias são realizadas de forma indolor, permitindo aos pacientesum estado de relaxamento completo, proporcionando ao cirurgião um procedimentode realização mais simples e confortável.

Background: The peribulbar anesthesia for inferior blepharoplasties was employed successfullyin selected patients over the last 9 years. This technique is largely accepted forophthalmologic procedures but yet not specifically employed for blepharoplasties. Methods:788 patients with ages ranging from 36 to 77 years old were submitted to inferior peribulbaranesthesia for blepharoplasty procedures, 623 (79%) were female and 165 (21%) were male.Results: None of our treated patients complained of pain or discomfort during or after thesurgical procedure. Immediate chemosis after inferior peribulbar anesthesia was observed in17 (2.2%) cases, orbital hematoma was observed in 3 cases (0.4%) and diplopya or a slightimaging distortion may occur after inferior peribulbar anesthesia, lasting a few hours. Conclusions:The inferior peribulbar anesthesia for blepharoplasties offers surprising results.The surgical procedures are performed pain-free, leaving the patients completely relaxed,allowing an easier surgical procedure.

Acesso a medicamentos para AIDS: lições da iniciativa brasileira / Acess to medicines for AIDS: lessons from the Brazilian initiative

Este artigo situa a inicitaiva brasileira de distribuição de medicamentos para Aids na integração do esforço global para o estabelecimento de politicas que favoreçam o acesso a medicamentos, sobretudo nos paises em desenvolvimento. Para tal, mencionam-se e analisam-se algumas das iniciativas em andamento que visam ampliar o acesso a medicamentos, para pessoas com HIV/AIDS