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HIV PROTEASE INHIBITORS U.S. Patent No. 5,413,999 Issued:May 1995 to Joseph Vacca and others Assigned tMerck & Co. Inc. Prosecuted by:In-house at Merck Protease inhibitors aren’t a cure for HIV infection, but they can keep the disease manageable — and have helped to drastically reduce the number of deaths from AIDS. Approved for use in 1995, the inhibitors have shown a remarkable ability to suppress HIV viral loads, particularly when taken in a “triple cocktail” with two other drugs called reverse transcriptase inhibitors. By inhibiting the virus’s protease enzyme, the drugs prevent viral replication — in essence, holding the virus in check and keeping it from developing into full-blown AIDS. It didn’t take long for these drugs to work their magic, either. In 1997 the number of AIDS-related deaths in the U.S. dropped by 47 percent, according to the Food and Drug Administration. Protease inhibitors have also called attention to a major criticism of the patentability of life-saving drugs: Manufacturers, using patents, can set prices so high the drugs cannot be obtained by many of the people who need them. Merck’s Crixivan, the most widely used protease inhibitor, costs over $6,000 a year in the United States. But the vast majority of HIV-infected individuals live in the world’s most impoverished nations, particularly in southern Africa, where over 250,000 people died of AIDS in 2000. Under pressure to provide greater access to medication, Merck announced last year that it would cut the price of Crixivan in developing nations to $600 a year — a level, the company says, at which it will make no profit. But even that price is too high for most patients, who must rely on charities and relief groups to buy the drugs for them. Alan Cohen is a free-lance writer based in New York City. His e-mail is [email protected].

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