Miami Herald - December 1, 2005
Jacob Goldstein, jgoldstein@herald.com

Antiretroviral drugs have achieved spectacular success in prolonging the lives of Americans with HIV, the virus that causes AIDS.

But can they work equally well in a country with wretched poverty, social unrest, political upheaval and a dearth of doctors and medical clinics?

A new study out of Haiti says they can.

The study published today -- World AIDS Day -- in the New England Journal of Medicine found that the drugs tripled the survival rates of Haitians with AIDS. It highlights the promise of bringing AIDS therapies to the developing world, where the epidemic is exacting its harshest toll.

"It can be done almost anywhere in the world," said Dr. Jean William Pape, one of the study's authors. "We don't need the excuse of the political situation, social unrest. These things exist; they should not be an excuse for not delivering care."

The study of 1,004 patients was the first large-scale test of AIDS therapies in Haiti. The drugs boosted one-year survival rates from 30 percent in both adults and children to 87 percent in adults and 98 percent in children. The results were comparable to those in U.S. clinics.

Haiti, where annual per capita income hovers around $400, is the poorest country in the Western Hemisphere. Three percent of Haitians are infected with HIV, the highest rate outside of sub-Saharan Africa.

Skeptics have argued that the high cost of AIDS drugs, the complexity of administering them properly and the lack of medical infrastructure would make delivery of drugs unrealistic in poor countries, said Dr. Andre Vulcain, who coordinates AIDS care for the University of Miami's program in Cap-Haitien.

"For many years, the international community had a lot of reservations in promoting treatment for HIV/AIDS in developing countries," he said.

STANDARD THERAPY

Standard AIDS therapy, known as highly active antiretroviral therapy, or HAART, involves taking at least three drugs per day. In patients who fail to take the drugs consistently, the AIDS virus often mutates to become drug resistant. And in the developing world, AIDS patients must often be treated for a wide range of other problems, ranging from malnutrition to tuberculosis.

Despite those challenges, Haitians in the study fared well: The amount of virus in their blood decreased and their immune systems grew stronger at rates comparable to those of patients in the United States. "This study will allow the international community as well as the government of Haiti to advance with more confidence toward access to HIV care for infected people," Vulcain said.

The rate of HIV in Haiti has fallen in recent years. And since 2003, when the price of AIDS drugs fell dramatically in the developing world with the introduction of generics, the number of Haitians on antiretroviral therapy has increased steadily.

Of the estimated 200,000 HIV-positive Haitians, 20,000 probably need antiretroviral therapy, Pape said.

Five thousand are on therapy now, and the number could be twice that by the end of 2006.

The increase is being driven by millions of dollars in international aid, which funds the purchase of the drugs and several programs that train personnel to administer the drugs throughout the country.

Treating the patients in the study cost $1,600 per patient per year, which includes, among other costs, $600 for drugs, $450 for personnel and $300 for lab costs.

MORE THAN DRUGS

The study's authors emphasized the need to address poverty and political conditions as well as deliver drugs.

Some patients were given rice, beans and cooking oil along with their medicine. In the days leading up to the overthrow of President Jean-Bertrand Aristide in February 2004, the clinic sent drugs home with staff who lived in different parts of the city so that patients who could not travel to the clinic could pick up their pills at the homes of the clinic staff.

"It can be done this way," he said. "All you need is the will to do it."

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