TORONTO, Aug 16, 2006 (AFP) - Drugs that tackle HIV are at last moving out to poor, AIDS-hit countries in significant volumes and new treatments are starting to emerge from the research pipeline, the International AIDS Conference heard Wednesday.
The encouraging news is leavened, though, with concern about the pace of the drug rollout in sub-Saharan Africa, on the world's poorest continent and also the worst hit by AIDS.
An estimated 38.6 million people around the world have HIV. Of these, 6.8 million people in low- and middle-income countries are so badly infected that they need antiretroviral treatment.
Three years ago, the number of people who had access to these lifeline drugs was just 400,000.
By the end of June, the total had risen to 1.65 million, or 24 percent of those in need, the World Health Organisation (WHO) announced here on Wednesday. At the end of 2005, the figure was 1.3 million.
"While the 76 percent still untreated represents a predominantly empty glass, trends in scaleup have nonetheless been encouraging in the areas with the most people with HIV," Kevin De Cock, director of the WHO's Department of HIV/AIDS, said.
"In sub-Saharan Africa, over a million people are now on treatment, a tenfold increase since December 2003, (with) Africans now representing 63 percent of all treatment recipients," he said.
By region, coverage ranged from only five percent in North Africa and the Middle East to 13 percent in Eastern Europe and to 75 percent in the Caribbean and Latin America.
He added: "In Asia, a more than threefold increase has occurred in two years. At least 20 low- and middle-income countries are treating over 50 percent of their citizens in need."
ART is the famous "cocktail" of powerful drugs that prevent the AIDS virus from hijacking the CD4 immune cell and then replicating, leaving in its wake a wrecked cell.
Beyond a certain threshold of infection, the immune defences become so badly damaged that the body is exposed to opportunistic diseases such as tuberculosis and pneumonia.
Antiretrovirals suppress the virus level to manageable levels but are not a cure, which means a patient has to take them for the rest of his or her life.
Julio Montaner, professor in AIDS research at the University of British Columbia, said AIDS drugs had evolved "in a fairly dramatic fashion" since the cocktail emerged a decade ago.
Thanks to a single-dose combination tablet, patients who in 1996 had to take eight pills a day now only had to take one.
"On every step of the road, we continue to make things simpler for our patients," he said.
As for those who worried that the drugs could be misused in Africa, this was entirely false, he said. Africans adhere more tenaciously to the drug regimen than Americans, according to a study.
And with common sense and by using nurses or care workers to do simple tasks in patient monitoring that in the West are often performed by doctors, the drugs can be distributed despite a lack of skilled personnel or labs to test CD4 and virus levels.
New treatments, too, are emerging.
"We are blessed with a large number of drugs in the pipeline," said Montaner, referring to a trio of second-generation molecules that could hit the market within a couple of years and to so-called "salvage therapy" that has enabled patients who were almost at death's door to resume a normal life.
But de Cock and Montaner insisted there was no cause for complacency.
"Sub-Saharan Africa still accounts for 70 percent of the world's unmet treatment need," said De Cock. Added Montaner: "Ninety percent of the drugs are in the north of the world, while 90 percent of the patients are in the south of the world... let's bring the treatment to the people as they need it."
Two-thirds of the global total of people living with HIV/AIDS live in sub-Saharan Africa.
Even though antiretrovirals first emerged in 1996, it took seven years -- and a political firestorm -- before the precious drugs began to arrive in Africa in significant volumes.
The tragic delay, in which millions of lives were lost, was mainly because of the high price of drugs.
In 2003, the situation changed. The price plummeted, thanks to concessions by Big Pharma and competition by makers of cheaper copycat drugs, and funds to help distribute them started to flow, thanks in large part to President George W. Bush's 15-billion-dollar, five-year AIDS programme.
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