Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Bangkok Post - January 23, 1999
Aphaluck Bhatiasevi
Anti-retroviral drugs like zidovudine or AZT can be prescribed only to HIV- positive pregnant patients, to stop vertical transmission to their newborn babies, according to the latest Essential Drug List. HIV-positive patients can obtain other anti-retroviral drugs like ddI and ddC only if they join the Ministry of Public Health's Aids research project.
The 1999 Bangkok Symposium on HIV Medicine, organised by HIV Netherlands Australia Thailand Research Collaboration, was attended by some 100 medics working on patients with HIV/Aids.
Praphan Phanuphak, director of the Red Cross Aids Research Centre, said the two clauses may result in double-standard treatment of patients attending different hospitals because some hospitals choose to omit the drug from their lists of essential drugs to cut costs.
Due to budgetary constraints, most hospitals prefer to avoid using expensive drugs on their patients because they have to subsidise the drugs, he said.
Taking the example of Chanthaburi and Chiang Rai hospitals, Dr Praphan said HIV/Aids patients have complained that they have to purchase the drugs themselves because the two hospitals do not keep AZT on their shelves at all.
He said that since Chulalongkorn Hospital permits subsidised prescription of only AZT, he has had to send patients with reference notes to Siriraj Hospital so that they can obtain other drugs like ddI and ddC.
The policy of providing zidovudine to HIV/Aids patients was initiated during the Anand Panyarachun government over five years ago, but due to management problems, it was halted three years back.
Currently, patients can prescribe anti-retroviral drugs at a subsidised rate only if they join in the Ministry of Public Health's Aids research project, where they would have to be closely followed-up by physicians.
In addition, Dr Praphan pointed out that there is a large variation in prices of drugs used on HIV/Aids patients.
While a 100 mg AZT can be obtained at 12.35 baht from one hospital, its price is set at 25 baht in another hospital, he said.
Worse still, Dr Praphan said the price of a 200 mg fluconazole, which is used for treating fungal infection in the brain, varied between 33 and 220 baht in different hospitals.
The difference in price is due to the mark-up each hospital makes, which varies between 5-20 percent, he said.
Kiat Ruxrungtham of Chulalongkorn Hospital said studies conducted both in Thailand and abroad clearly show that the use of anti-retroviral drugs can improve the quality of life of patients with HIV/Aids.
Quoting studies carried out in the West, he said it has been proved that the use of AZT alone helps improve the life of an HIV/Aids patient by six months, the use of a double combination drug is good for 27 months, adding that the results of triple combination drugs is even better.
Among Thai patients, Dr Kiat said a study conducted on HIV/Aids showed that the combined use of d4T and ddI reduced the virus load by 70-80 percent within a year.
Jureerat Bovonwatnuvong of Chon Buri Hospital who has been actively involved in treating HIV/Aids patients said though it is not possible to have the same standard of treatment for all Thai patients, hospitals should at least have a standard that is sufficient to improve the quality of life of their patients.
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