m e s s a g e f r o m t h e e x e c u t i v e The pharmaceutical industry is a complex and highly politi- cal business. A friend of mine in the industry refers to them as ‘the new tobacco companies’ because of their recently acquired status as the world’s new industrial bad guys. In some cases this has been well deserved. In South Africa, the battle to drive indefensible antiretroviral drug prices down was a sad part of our history that cost many lives. As new and novel compounds arrive on the market, with a tension between clinical need, affordability and reasonable profit, this battle is likely to continue. However, a new situation has now arisen. With the huge increase in the number of people on antiretroviral therapy (ART) in southern Africa, the need for sustainable (both in terms of supply and affordability) drug supply is an increas- ing concern. South Africa alone has about 400 000 peo- ple on ART. The annual ingredients for these drugs can be measured in tons, and many ingredients are only available from outside our borders. This makes our country extraor- dinarily vulnerable. If there is any interruption in the supply of these ingredients, or of the imported complete drug, we will face a major treatment interruption, with all the conse- quences of undermining adherence, promoting resistance and clinical progression. This threat is increasingly becom- ing a national security issue for the government, with HIV treatment a graphic illustration of the risks we face if we do not secure the industry. Discussions are underway between the South African Department of Trade and Industry and the local pharmaceutical industry with a view to supporting the industry, especially generic manufacturing, in securing local capacity. The new tenders for ART in the South African state sector are looming fast, with huge orders. We need a robust, flex- ible and strong drug manufacturing industry in our region, to guarantee that our patients are not exposed to needless treatment interruption risks. FRANCOIS VENTER President Anglo’s Dr Brian Brink, the Department of Health’s Dr Nomonde Xundu and Dr Francois Venter at Aspen’s factory in Port Elizabeth on a fact-finding visit. THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE                                                         SUMMER  2008 5 We are well into 2008, and government reports suggest that more than 400 000 South Africans are now receiving life-saving antiretrovirals. This makes our programme the biggest in the world, but there is no room for complacency, with another 500 000 requiring therapy over the next few months. A daunting task, as initiation is just the beginning - these patients need care for the rest of their lives. In this summer edition the adult treatment guidelines have been revised. Anyone providing care for HIV-infected patients should familiarise themselves with these guidelines. The guidelines describe the proposed role of tenofovir in the South African ART programme, and on p. 8 Nathan Ford and co-authors describe what needs to be done to bring its price into a range that would make it affordable and pos- sible for first-line consideration. We are also delighted to feature the rest of the much sought-after nutritional guideline chapters. Dr Dave Spen- cer has been the driving force behind these, and we thank him and the team for their commitment. We pay tribute to Dave, who is retiring from the HIV Clinicians Society ex- ecutive committee. He is much loved and respected in this country as a devoted and wise HIV treater and an excep- tionally talented trainer. One of his memorable attributes is making any question sound like an excellent one! Dr Fabian and co-authors have contributed an excellent review on HIV and the kidney. Again, with tenofovir on the cards, bet- ter understanding of the renal pathologies expected in HIV and the complications of drugs and drug dosing is para- mount for good management. Finally, in the roll-out of ART and PMTCT, a number of excellent community-led projects have developed throughout Africa, often using the one re- source we do not have a shortage of: people living with HIV. One such programme, which has grown from Cape Town and now extends throughout Africa, is mothers2mothers, described in this edition by Chloe Teasdale. As we go to print, we have had the sad news that an HIV/ TB, public health and human rights warrior, Dr Ivan Toms, passed away in Cape Town over the Easter weekend. Ivan, a colourful and passionate doctor who lived life to the full and never compromised, was a South African who will be sorely and sadly missed. I am sure you will again agree: a fabulous smorgasbord of information in this our summer edition. Please keep articles rolling in – we have a series of critical guidelines coming up, but we need interesting and relevant original articles as well. Articles are EASILY submitted by going to www. sahivmed.org.za and registering as an author. Thereafter log in, proceed to 'user home', click on 'author' and follow the instructions for submission. LINDA-GAIL BEKKER Editor F R O M T H E E DI TOR pg5.indd 1 4/4/08 9:05:07 AM