Inter Press Service - May 18, 2000
Marwaan Macan-Markar

Medical experts have questioned whether the countries of Africa, many of which are listed among the poorest in the world, have the health infrastructure to ensure that the boon of cheaper drug therapy will benefit the country and those suffering from the Human Immunodeficiency Virus (HIV) rather than harm the population at large.

What is required are "strong medical and social-infrastructure to sustain the introduction of anti-retroviral drug therapies in resource-limited settings," asserts the International Association of Physicians in AIDS Care (IAPAC), a Chicago-based medical association.

IAPAC's concern has been reflected in other quarters, too. United Nations Secretary-General Kofi Annan has remarked that any reduction in the price of drugs will have to be combined with improving "delivery capabilities" and follow-up on patients. "So there is a whole range of activities which will need to be brought on board."

Likewise, a spokesman for Glaxo Wellcome - one of the five multinational companies which last week struck a deal with the United Nations to provide cheaper HIV drugs to Africa - has observed that governments who stand to benefit need to focus on "secure distribution channels."

"You're not going to solve the problem unless you've got the infrastructure -- the nurses, the doctors, the secure distribution channels - and unless you have governments that actually want to do something about it," James Cochrane, director of Glaxo's international division told a British newspaper.

The World Health Organisation (WHO), however, feels confident with what a number of African countries have to offer. According to Dr. Paula Munderi, of the WHO's HIV/AIDS (Acquired Immune Deficiency Syndrome) Initiative, the required monitoring systems are "in place at research centres and at well-resourced urban hospitals" in several parts of Africa.

The WHO, she adds, has "no details on the particular African countries lacking these facilities."

Currently, the therapy prescribed for HIV patients includes a combination of three drugs chosen from each of the three major classes of anti-retroviral medication. For some patients, though, the combination can range from a two-drug "cocktail" to a four- drug mix. In all, there are 15 anti-retroviral drugs approved and licensed for use in HIV infections.

In addition, says Munderi, patients suffering from HIV are often on a course of other medicines to treat and control the symptoms of HIV-related illnesses. Monitoring such medication helps to measure "toxicity levels" in the patients, points out the UN department dealing with AIDS (UNAIDS). "This needs to be done frequently at the beginning of the treatment, (meaning) monthly during the first three months and every other month thereafter."

During such laboratory tests, patients are checked for the toxic effects of the drugs in the liver, the kidney, the pancreas, the blood forming system and the metabolism of fats.

Furthermore, tests are also conducted to establish the salutary effect the drugs are having on the HIV levels in the blood and the "integrity of the immune system."

Failure to do so can result in dire consequences for both the patients and a country's population. "Immediate risks are that individual patients who take drugs to which their viruses have become resistant not only do not benefit, (but) they also become poorer (in health) and will suffer the side effects of the drugs for no good reason," says UNAIDS.

The long-term risk, it adds, will be felt on a country's population. "You might lose the efficacy of the drugs at population levels because the circulating virus strains might become resistant."

According to IAPAC, the prevailing monitoring mechanisms for HIV patients are far from complete. What is required is a globally recognised "HIV certification process."

The organisation, which counts among its members more than 10,000 physicians from 43 countries says it is currently developing an HIV certification process "through which HIV/AIDS-treating physicians globally may gain core clinical competence in the management of HIV disease".

Such a certification process, which will include both a basic HIV medicine programme and an advanced schedule focusing on the optimal use of anti-retroviral drug therapies, is comprised of a "comprehensive, continuing medical education course and examination."

Despite its concerns, however, the IAPAC was among those who welcomed last week's announcement by the drug companies to dramatically slash the price of anti-HIV drugs by as much as 85 to 90 percent for patients in Africa, which has close to 23 million people infected with HIV.

"These discounts represent hope for a significant fraction of the African AIDS population," it commented.

Under the current arrangement, the five multinationals - Bristol- Meyers Squibb, Glaxo Wellcome, Merk and Company, F.Hoffman-La Roche Holding and Boehringer Inglhiem - have agreed to distribute their drugs through the United Nations or UN-related programmes.

And the cost for each patient dependent on such drug therapy could amount to two dollars a day, which, according to one estimate, would be one-seventh of the price in the United States.

Nevertheless, the prospect of such cheaper drugs was not welcomed by the international medical aid agency Doctors Without Borders. "This agreement does nothing to stimulate countries' rights to produce or import inexpensive high-quality drugs, a key component to long-term, sustainable solutions for improving access to essential medicines," it remarked.

The need for monitoring mechanisms for anti-HIV drugs has also not been lost on this agency. Its current global campaign to secure essential medicines at affordable prices for the world's poor also includes regular efforts by its research teams to identify the "needs of patients" for safe and secure treatment. (END/IPS/HE/mmm/da/00)
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