According to the data, the number of people infected with AIDS in the world reached 38 million in 2019, an increase of 1.88% year-on-year, including 1.7 million new cases. In China, there are 71,200 new AIDS cases with an year-on-year increase of 10.96%. At present, about 1 million people are infected with HIV in China, and the number of new cases has been increasing. 

Cocktail therapy for fighting AIDS 

Up till now, although there is still no effective cure method for AIDS in the world, this terminal disease can be transformed to chronic disease by cocktail therapy.

The so-called cocktail therapy is to use a variety of antiviral drugs simultaneously or sequentially to treat AIDS. Different antiviral drugs can produce synergistic effects on different links in the reproductive cycle of HIV, inhibit the replication of the virus to the maximum extent, partially restore the immune function of the body, so as to slow the progression of the disease and prolong the lifetime of patients. 

The advice given by the World Health Organization (WHO) and from Chinese Guidelines for Diagnosis and Treatment of HIV/AIDS is that the one diagnosed with HIV should promptly accept combined antiretroviral therapy regardless of CD4+T lymphocyte level. 

It shall be noted that the AIDS patients need to take medicine for life if they want to transform such incurable disease to chronic disease by cocktail therapy. At present, there are 6 categories and more than 30 kinds of antiretroviral drugs (including compound preparations) in the world, including nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase inhibitors (INSTIs), membrane fusion inhibitors (FIs) and CCR5 inhibitors.

For adults and teenagers infected with HIV, the recommended treatment schemes of cocktail therapy in Guide of China Medicine include 6 first-line treatment schemes and 4 alternative treatment schemes. 

Data source: public data compilation

Top 10 AIDS cocktail drugs in global sales 

At present, there are 70 anti-HIV single and compound drugs on the market in the world, most of which are mainly developed by ViiV, Gilead, GSK and other companies. 

By 2020, the global market scale of anti-HIV drugs has reached 40.92 billion US dollars, of which North America, Central and Western Europe take the lion's share. In 2020, the sales of Top 10 anti-HIV drugs totaled 22.8 billion US dollars. Among them, Gilead takes the lead, developing 6 kinds of drugs of TOP 10 drugs, with accumulated annual sales exceeding 15.9 billion US dollars, and accounting for nearly 70% of the total sales of TOP 10 drugs. 

Data source: public data compilation 

Current situation of market of HIV therapeutic drugs in China 

At present, the HIV therapeutic drugs on the market in China include nucleoside reverse transcriptase inhibitors (NRTIs), nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase inhibitors (INSTIs) and membrane fusion inhibitors (FIs). It involves more than 20 varieties on sale. The major foreign-funded enterprises include Gilead, GSK, Johnson & Johnson, MSD, etc., and the pharmaceutical enterprises and bio pharmaceutical companies in China include Glaxosmithkline, Brilliant Pharmaceutical, Cosunter Pharmaceutical, Northeast Pharm, Anhui Biochem, Huahai Pharmaceutical, etc. 

Anti-HIV drugs sold in the Chinese market are mainly imported drugs and domestic generic drugs, and more than 80% of the market share is controlled by foreign-funded enterprises. Currently, more than 40 Chinese pharmaceutical companies are engaged in domestic generic drugs, among which the Glaxosmithkline has a market share of more than 30%, and the total market share of top three companies, Glaxosmithkline, Brilliant Pharmaceutical, Cosunter Pharmaceutical exceeds 65%. In the field of Chinese innovative drugs, long-acting FIs albuvirtide of Frontier and NNRTIs ainuovirine of Aidea Pharmaceutical were listed in 2018 and 2021 respectively. After entering to the market, albuvirtide for injection has gotten good response. 

Since 2009, more and more HIV therapeutic drugs have been included in the scope of medical insurance payment, including emtricitabine, emtricitabine + tenofovir, zidovudine injection, nevirapine, zidovudine and lamivudine tablets, etc., providing more treatment options for AIDS patients. According to the data of Chinese sample hospitals in 2020, tenofovir and lamivudine account for 70.86% and 7.44% of domestic market share respectively, ranking top two, and the market shares of other drugs are relatively small. 

About  the Author:    

Xiaoyaowan, a pharmaceutical industry practitioner, a word carrier in the We-media era focusing on changes of the pharma industry.