Indonesia has done this before. Now, the Southeast Asian nation is considering issuing compulsory licenses for another three AIDS meds in order to produce cheaper versions, Intellectual Property Watch reports.

Apparently, existing funding for three second-line drugs could dry up soon, according to Samsuridjal Djauzi, a physician who is involved in the government’s compulsory licensing activities, IPW writes. Some HIV/AIDS patients develop resistance to their first-line drugs during the course of their treatment and need these second-line meds to boost their immunity.

The three under consideration are Gilead’s Viread, Bristol-Myers Squibb’s Videx, and Abbott’s Kaletra, says Djauzi, who teaches medical science at University of Indonesia in Jakarta and works at a clinic to help HIV/AIDS patients. He spoke on the sidelines of a meeting last week on compulsory licensing in Bangkok. His working group is now collecting data about the three drugs in order to make proposals to the health minister, who will make the decision.

Djauzi says if compulsory licences are issued, Indonesia might have to import ingredients from India, but would make generic versions locally. He adds that prices of these second-line meds have come down since the local industry started to produce generics of first-line drugs, but he was uncertain whether drugmakers would keep prices low without the pressure of potential compulsory licences and competition from generics.

“They might cut the price now, but for how long?” the Indonesian doctor says. “However, the society wishes for a sustainable supply of (anti-retroviral drugs) with affordable price. Therefore, the option of producing them in our own country is much desirable.”

Djauzi says currently about 10,000 Indonesian patients are on first-line ARVs and usually less than 5 percent of the patients would develop resistance and would need the second-line ARVs, which are more expensive. The Global Fund to Fight AIDs, Tuberculosis and Malaria now supplies these second-line ARVs to Indonesia, but Djauzi believes the supplies might dry up soon as the fund might decide to cut its aid to the country, IPW writes.

Indonesia first issued a presidential decree to use compulsory licensing for two HIV meds - Glaxo’s Epivir and Boehringer Ingelheim’s Viramune - in 2004. In March 2007, the decree was renewed to cover another ARV drug efavirenz, which replaced nevirapine as the first-line treatment.

Indonesia uses Epivir, Retrovir and efavirenz as the three first-line meds for HIV/AIDS patients, but didn’t impose a compulsory licence on Retrovir as its patent had earlier expired. These three drugs are now produced locally by PT Kimia Farma, a state-owned pharmaceutical company.

In a paper presented at the Bangkok meeting, he says that while the number of Indonesians affected with HIV/AIDS is estimated at 190,000 to 210,000 in 2006, patients receiving treatment amounts to 10,000 and the number could possibly rise to 30,000 at the end of 2008. He later tells IPW that without an effective control program, the number of those affected by HIV/AIDS in Indonesia could jump to one million in 2010.

“In the long term, the generic version of patented drugs will be wider used in developing countries,” he says.