New Strawberry-Flavored H.I.V. Drugs for Babies Are Offered at $1 a Day


About 80,000 babies and toddlers die of AIDS each year, mostly in Africa, in part because their medicines come in hard pills or bitter syrups that are very difficult for small children to swallow or keep down.

But on Friday, the Indian generic drug manufacturer Cipla announced a new, more palatable pediatric formulation. The new drug, called Quadrimune, comes in strawberry-flavored granules the size of grains of sugar that can be mixed with milk or sprinkled on baby cereal. Experts said it could save the lives of thousands of children each year.

“This is excellent news for all children living with H.I.V.,” said Winnie Byanyima, the new executive director of UNAIDS, the United Nations agency in charge of the fight against the disease. “We have been eagerly waiting for child-friendly medicines that are easy to use and good to taste.”

Cipla revolutionized the provision of AIDS drugs for adults almost two decades ago, pricing them at $1 a day. The new pediatric formulation will likewise be priced at $1 a day. The announcement by Cipla and the Drugs for Neglected Diseases Initiative, an offshoot of Doctors Without Borders that supported the development of the drug, was timed to coincide with World AIDS Day, which is Sunday.

Moreover, each drug must be squirted into a child’s mouth with a separate syringe, so a mother must have up to four syringes on hand and clean them for each subsequent use. Children generally have to take the medicines twice a day for the first four years of life. When liquid versions are unavailable, some pills cannot be crushed and mixed in juice; they must be swallowed whole.

In contrast, Quadrimune contains four H.I.V. drugs: ritonavir, lopinavir, abacavir and lamivudine. The granules are coated first in a polymer that doesn’t melt until it reaches the stomach, and then with sweet, fruity flavoring.

Dr. Kogie Naidoo, who heads treatment research at Caprisa, an AIDS treatment and research group based in Durban, South Africa, who was not involved in Quadrimune’s development, said the new formulation could solve many problems she and her colleagues encounter while treating children.

Cipla, founded in 1935, was the first generic drug company to offer H.I.V. drugs in Africa. In 2001, its chairman, Yusuf K. Hamied, upended the global pharmaceutical industry by offering to supply a three-drug cocktail to Doctors Without Borders for $1 a day.

At the time, multinational drug companies were charging up to $15,000 for their regimens and refusing to lower prices except in secret negotiations with a few countries and were working to block generic competitors from the market. An estimated 25 million Africans were then infected and thousands were dying every day. (The industry was also suing South Africa’s president, Nelson Mandela, over a law he had signed authorizing the government to cancel drug patents and award them to generic makers.)

In 2001, Dr. Hamied said he was losing money at the $350 a year price; his break-even point was $600, he said, and he offered it to other buyers for that.

But he said he acceded to requests from AIDS activists for the $1 a day price to deliver a shock to his Western competitors and because such a nice round figure was likely to make headlines (a gambit he is clearly repeating now).

In the decades since, increased generic competition has driven the price of triple therapy in poor countries to below $100 a year.

“Over the past 20 years, Cipla has pioneered fixed-dose combinations for children and I do believe our Quadrimune could be a winner,” Dr. Hamied said in an interview this week.

Because all four drugs in the formulation are older and no longer patented, Cipla might eventually offer it in wealthy countries too, he said. But that market is quite small because most pregnant women in the West are tested for H.I.V. and immediately put on antiretroviral drugs, which reduces to near zero the chances that they will infect their babies in the womb, during birth or through breastfeeding.

The $1 a day price is for Quadrimune doses appropriate for children of between 20 and 30 pounds, he noted, so the cost for newborns would be even lower.

Paradoxically, treating infants with H.I.V. has actually become harder in recent years than it was two decades ago.


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