Generic healthcare drugs soon to be available in the US could save the healthcare system nearly $1m but are less effective than branded drugs currently in use, according to doctors writing in a US journal.

In the Annals of Internal Medicine journal doctors write that trial data suggests that generic HIV drugs are less efficient and could result in 4.4 months of life lost per patient lifetime.

Also, new generic drugs require patients to take one pill three times a day instead of one single pill a day, meaning more patients could forget to take their medication which could also result in reduced efficiency.

However, the lifetime financial savings to the healthcare system would be $42,500 (£26,500) per patient, say the Massachusetts General Hospital investigators.

Lead researcher Dr Rochelle Walensky is reported by the BBC as saying: "This is a trade-off that many of us will find emotionally difficult, and perhaps even ethically impossible, to recommend."

Currently, standard recommended treatment for a HIV patient is a single dose of Atripla, which contains three brand-name antiretrovirals – tenofovir (Viread), emtricitabine (Emtriva) and efavirenz (Sustiva), taken daily.

"This is a trade-off that many of us will find emotionally difficult, and perhaps even ethically impossible, to recommend."

Patients could soon start taking brand drug tenofovir alongside a generic version of efavirenz, which is expected to become available soon, and another generic drug that has a similar mechanism of action to emtricitabine that became available in January last year.

Dr Walensky concedes that for those who stick solidly to the treatment regime this generic drug combination could be just as effective. However, those who miss a pill face treatment failure. She added that the situation might be more acceptable if the financial savings were to be redirected to other aspects of HIV treatment.

Jason Warriner of the Terrence Higgins Trust, a UK HIV charity, speaking to the BBC, said: "There are around 7,000 people diagnosed annually in the UK, meaning the cost of anti-HIV drugs is rising year on year.

"With the NHS under unprecedented financial pressure, the spread of the epidemic is a challenge not just for public health but for the public purse.

"Introducing generic medications would be one way for the health service to reduce expenditure, but this must not be at the expense of patient health.

"Anything that compromises the effectiveness of anti-HIV drugs, or makes people less likely to stick to treatments, would be a false economy."

He added: "Effective medications not only keep those living with the virus fit and well, they also help to keep down new infections."

Image: Scanning electron micrograph of HIV-1 (in green) budding from cultured lymphocyte. Image courtesy of the CDC Public Health Image Library.