Background: Indian manufacturers of generic antiretroviral (ARV) medicines
facilitated the rapid scale up of HIV/ AIDS treatment in developing countries though provision of low-priced,
quality-assured medicines. The legal framework in India that facilitated such production, however, is changing with
implementation of the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights,
and intellectual property measures being discussed in regional and bilateral free trade agreement
negotiations. Reliable quantitative estimates of the Indian role in generic global ARV supply are needed to
understand potential impacts of such measures on HIV/AIDS treatment in developing countries.
Methods: We utilized transactional data containing 17,646 donor-funded
purchases of ARV tablets made by 115 low- and middle-income countries from 2003 to 2008 to measure market share,
purchase trends and prices of Indian-produced generic ARVs compared with those of non-Indian generic and brand
Results: Indian generic manufacturers dominate the ARV market, accounting for
more than 80% of annual purchase volumes. Among paediatric ARV and adult nucleoside and non-nucleoside
reverse transcriptase inhibitor markets, Indian-produced generics accounted for 91% and 89% of 2008 global
purchase volumes, respectively. From 2003 to 2008, the number of Indian generic manufactures supplying ARVs
increased from four to 10 while the number of Indian-manufactured generic products increased from 14 to 53.
Ninety-six of 100 countries purchased Indian generic ARVs in 2008, including high HIV-burden sub-Saharan
African countries. Indian-produced generic ARVs used in first-line regimens were consistently and considerably less
expensive than non-Indian generic and innovator ARVs. Key ARVs newly recommended by the World Health Organization
are three to four times more expensive than older regimens.
Conclusions: Indian generic producers supply the majority of ARVs in
developing countries. Future scale up using newly recommended ARVs will likely be hampered until Indian generic producers
can provide the dramatic price reductions and improved formulations observed in the past. Rather than agreeing
to inappropriate intellectual property obligations through free trade agreements, India and its trade partners
- plus international organizations, donors, civil society and pharmaceutical manufacturers - should ensure that
there is sufficient policy space for Indian pharmaceutical manufacturers to continue their central role in supplying
developing countries with lowpriced, quality-assured generic medicines.