MSF reported the problem arises from new World Trade Organization agreements and patent regulations that can block the manufacture of generic drugs. A new report said middle-income countries “are increasingly taking measures to overcome the patents that price drugs out of reach.”

Patients start out on what’s called a first line regimen of medication. If for some reason that fails, or has too many side effects, they are put on a second-line and then a third line of treatment. But second and third line drugs are much more expensive.

Leena Menghaney is with Doctors Without Borders Access Campaign in India, which is a leader in the manufacture of generic drugs. However, she said there’s now a need for newer, expensive antiretrovirals – especially since more patients are co-infected with XDR-TB. That’s a strain of tuberculosis that’s become drug resistant.

Leena Menghaney, MSF, Acess campaign, India (De Capua)

“We are working in Mumbai, which is the epicenter or you can say the heart of where the first few AIDS cases came out. It’s a very complex epidemic in Mumbai. You have patients with XDR, but you also have patients who have been on first line and second line and have now started to need the newer drugs. Unfortunately, for us, what has happened is that we are paying more than $2,100 for just one single drug that we’re using in the third line regimen. And ethically speaking, as doctors, we cannot turn these patients away,” he said.