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Policymakers should consider not the cost of developing a vaccine against HIV, but the cost to society if it fails to develop one.1
In the developed world, some patients on antiretroviral treatment will develop drug resistance and the number will be cumulative each year. Medical care costs will increase exponentially for drug resistant patients, greatly exceeding the price of treatments.
Primary HIV-1 drug resistance ranges from 6.6% in Brazil to 10% in Spain to 27.7% in North America,2 perhaps because of more frequent testing in developed countries.
Yet, this may be a portent of what will come in the developing world. By the end of this year, two million people will probably be on AIDS treatment. Many come from resource limited settings, where initial testing is limited, adherence is problematic, and substandard drugs are used as first line treatment. Suboptimal adherence is the most important factor in virological failure. Adherence is low in resource limited settings, increasing the possibility of early onset of drug resistance.
If the rate of resistance in the developing world is around 10% then 200000 people would be drug resistant by 2010 and would move on to second line therapies. Second line treatments are over 20 times as expensive as first line ones,3 and patients on such treatments need care from skilled and relatively well paid medical professionals.
Failing to focus on developing an AIDS vaccine will lead to a sequential increase in the number of chronically sick people whose care and maintenance will prove financially unsustainable for donors and affected governments.
Competing interests: None declared.