Inter Press Service - November 3, 2000
Marwaan Macan-Markar

Delegates to the Forum 2000 conference will be taking a long hard look at the cost and benefits of this kind of drug therapy and its impact on the "quality of life and mortality reduction among people living with HIV and AIDS", stated a programme note.

The conference, which will run from Nov. 6 to 11, will also address aspects of universal and free access to anti-retroviral therapy for those infected with the Human Immunodeficiency Virus (HIV) that causes Acquired Immune Deficiency Syndrome (AIDS).

This event "represents a major opportunity for sharing doubts and difficulties concerning the development of scientific research, prevention, care and community action" regards this global pandemic, Dr. Paulo Teixeira, chairperson of Forum 2000 noted on the conference web-site.

Those expected to participate during the sessions will include researchers, scientists, health professionals, governmental and non- governmental organisations (NGOs), international health bodies and people from the region living with HIV and AIDS.

Such scrutiny of the anti-HIV drug regimen comes in the wake of solid support for such therapy to prevent HIV transmission from infected mothers to their children.

"There is no justification to restrict use of any of these (anti- retroviral drug) regimens to pilot projects or research settings," declared a statement released by a team of health experts in late October, following a technical consultation held in Geneva.

The safety and effectiveness of anti-retroviral regimens far outweigh potential adverse effects, added the Joint United Nations Programme on HIV/AIDS (UNAIDS). It "should be included in the minimum standard package of care for HIV-positive women and their children".

In a UNAIDS media release, Dr. Winnie Mpanju-Shumbusho, director of the HIV/AIDS Initiative of the World Health Organisation (WHO), observed, "the choice should be determined according to local circumstances on the grounds of cost and practicality, particularly as related to the availability and quality of antenatal care".

Every year, states UNAIDS, more than 600,000 infants are infected with HIV, mainly in developing countries. And since the beginning of the AIDS epidemic, an estimated 5.1 million children worldwide have been infected with the disease, with mother-to-child transmission being "responsible for more than 90 percent of these infections".

The treatment prescribed by health experts for HIV patients, in general, involves 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. But ready access to these drugs, alone, is not the only remedy against the AIDS epidemic, argues UNAIDS. "It also requires appropriate counselling and testing services."

Martin Foreman agrees. Regards counselling, one-to-one sessions are recommended both before and after laboratory tests, says Foreman, director of the AIDS Programme at the London-based Panos Institute. "Extensive counselling is needed because the physical and psychological impact of a positive test is severe." Tests should include drawing blood from the patient and having it tested in laboratories before the course of drugs is administered, he adds.

According to UNAIDS, furthermore, once a regimen of anti- retroviral drugs are taken, it is necessary to monitor such medication to measure "toxicity levels" in the patients and 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, argues UNAIDS, can result in dire consequences for both the patient 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," states UNAIDS.

The long-term risk, the UN body 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."

In May this year, in an effort to ensure easier access to such a drug regimen, the United Nations struck a deal with five pharmaceutical companies to explore ways of providing the anti-HIV drugs to patients in Africa at affordable prices.

And in late October, Glaxo Wellcome, one of the five pharmaceutical companies which had agreed to slash the prices of these drugs under UNAIDS' Accelerating Access Initiative, announced that the first price discount agreement had been reached between the government of Senegal, the pharmaceutical companies and the United Nations.

The three anti-retrovirals the Senegalese are due to receive include Retrovir, Epivir and Combivir.

The urgent need for such drugs in Africa has been underscored by a recent report on the devastating impact of the HIV/AIDS epidemic on that continent. "This year began with 24 million Africans infected with the virus. In the absence of a medical miracle, nearly all will die before 2010. Each day, 6,000 Africans die from AIDS. Each day, an additional 11,000 are infected," declared the Washington D.C.-based Worldwatch Institute this week.

The epidemic has proceeded much faster in some countries than in others, it added. "In Botswana, 36 percent of the adult population is HIV- positive. In Zimbabwe and Swaziland, the infection rate is 25 percent. Lesotho is at 24 percent. In Namibia, South Africa and Zambia, the figure is 20 percent."

Currently, according to UNAIDS, the total number of adults and children living with HIV/AIDS worldwide is estimated at 34.3 million. Of that number, Latin America and the Caribbean account for 1.6 million patients. And the death toll due to HIV/AIDS since the disease was first detected in the early 1980s has reached 18.8 million.

According to Foreman, anti-retroviral drugs need to be circulated more widely to counter such a grim reality. "There has been widespread awareness for several years among people working in HIV/AIDS that these drugs are available. But (there has been) much less awareness among the general public." (END/IPS/HE/mmm/da/00).
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