Inter Press Service - July 10, 2001
Marcela Valente

Such is the forecast of infectious disease specialist Pedro Cahn, of Argentina, chair of the first International AIDS Society Conference on HIV Pathogenesis and Treatment, underway in Buenos Aires through Wednesday, with the participation of more than 3,000 scientists, officials and activists from around the world.

"AIDS (acquired immuno-deficiency syndrome) has put the spotlight on problems like poverty, hunger, lack of housing and the total absence of bio-safety in the hospitals, all issues that predate the arrival of the virus" Cahn told IPS.

The short life expectancy in Ethiopia, just 45 years, was a problem before HIV (human immuno-deficiency virus), the precursor to AIDS, began to spread in that country, he cited as an example.

HIV, which causes the progressive deterioration of a person's immune system, is currently carried by nearly 40 million people worldwide, and causes the deaths of some three million annually. Seventy percent of the cases are recorded in sub-Saharan Africa, the world's poorest region.

The differences between poor and rich countries as far as access to treatment for the disease became starkly evident during the first day of the Buenos Aires meeting, Sunday.

Anti-retroviral treatments, which combine several medications and are known as "cocktails", reduce mortality rates 95 percent, but regular and uninterrupted access to these drugs varies greatly from one region to the next.

Stefano Vella, president of the Stockholm-based International AIDS Society, believes it is essential that the industrialised North pay higher prices for the medications and that the developing South receive them at cost, without paying patent rights to the pharmaceutical transnationals - a practice Brazil and South Africa have already adopted.

The two countries were the protagonists in a heated international dispute with the drug companies and with the United States government as they vindicated their right - during public health emergencies involving HIV/AIDS - to abstain from recognising intellectual property rights over the necessary drugs.

Within the last few months, the United States withdrew a case against Brazil pending before the World Trade Organisation, and a group of 39 transnational drug labs cancelled their case against the South African government in that country's courts.

Malawi's minister of Health and Population, Feliz Salaniponi, told the conference in the Argentine capital about his proposal to control HIV/AIDS using the same infrastructure utilised in fighting tuberculosis and malaria, attempting to take advantage of the same human resources, though with some additional training.

The financing of the initiative was the main target of the criticisms. Who will pay the cost of the drugs? Who will make sure that the patients have transportation to and from the clinics for treatment? How will the quality of the lab tests be verified?

The questions were left without answers. Sakaniponi's presentation was followed by that of doctor Jens Lundgren, of the Department of Infectious Diseases at the Hvidovre Hospital in Denmark, in which he outlined the results achieved in HIV/AIDS treatment in Europe.

There, it has been clear that results are very good when patients are assured access to the HIV/AIDS drugs and to ongoing treatment, though it is too soon to say that the disease can be kept under control in all cases, said Lundgren.

Nearly all experts from industrialised countries at the conference agreed that the combined anti-retroviral treatments still have two major obstacles to overcome.

First, there is fear that the virus will mutate and develop new strains that are resistant to the cocktail treatment. Second, the drugs have adverse effects, which is a key concern in a patient's acceptance of treatment. Among the negative effects is a predisposition to cardiovascular problems.

Along those lines, the presentation of Anthony Fauci sparked a great deal of interest. The doctor, head of the Washington-based Institute of Allergy and Infectious Diseases, has studied the results of implementing the anti-retroviral cocktail every other week.

According to Fauci's tests, HIV remains undetectable in the blood of the patients following this treatment schedule, which curbs the adverse effects of the medications on the body and, at the same time, reduces the costs of the therapy itself.

This variation of the cocktail is being implemented - though only among small groups - in the United States, Spain, Italy, France, and soon in Brazil. Argentina is also experimenting with this approach, though with even longer periods between drug administrations.

David Ho, director of the Diamond AIDS Research Centre in New York, cautioned that the combined treatments have not yet achieved complete eradication of the HIV. The virus tends to remain, for example, in the t-cells of the body's immune system.

Furthermore, said Ho, the drugs available today do not block reproduction of the virus 100 percent, though he stressed that the cocktail is currently the most effective tool in treating HIV/AIDS, as long as there is adequate control and follow-up in the administration of the drugs.

That is the most difficult part of treatment in developing countries, which lack resources to ensure effective control and consistent treatment for patients with HIV/AIDS.

Because of this, and despite the fact that the Buenos Aires conference focuses on the exchange of experiences in achievements and failures in treating the disease, the scientists gathered here continue to emphasise that prevention is still a top priority.
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