United Press International - Thursday, July 11, 2002
Ed Susman, UPI Science News

Such a strategy would be effective, researchers said, because in those resource-poor settings the virus has not yet mutated and remains highly vulnerable to the anti-retroviral drugs -- unlike the situation in Western countries where resistant virus transmission already means some drugs are no longer appropriate for even newly diagnosed patients.

"There is a whole world of susceptible virus out there," said Dr. Scott Hammer, professor of medicine at Columbia University in New York City. More than 90 percent of people infected by human immunodeficiency virus, which causes AIDS, never have received any anti-retroviral treatment, he said.

"When we begin to treat these people, we will see dramatic results," said Dr. Stephano Vella, head of the Italian anti-HIV/AIDS program in Rome and president of the International AIDS Society, the sponsor of the conference which has drawn more than 15,000 scientists, activists and related health care personnel.

"We saw dramatic results even when we treated people in the Western world who had been heavily pretreated with a catastrophic use of suboptimal therapy," Vella told United Press International. Suboptimal therapy breeds mutations in the virus -- mutations that block the effectiveness of drugs.

"One of the objections of people who have argued against treating people in developing countries had been a fear that we would create drug resistance," Vella said. "We can use the lessons we have learned in the West on how not to treat HIV infection to make sure we do it correctly when treating people in the developing countries."

International governments and organizations that have been donating money to groups such as the Global Fund to Fight AIDS, Tuberculosis and Malaria have pledged to begin treatment programs this year. Those programs will bring highly active anti-retroviral therapy, or HAART, to hundreds of thousands of people AIDS-ravaged southern Africa -- where 27 million HIV-infected people now live.

"There are few certainties in the world," said Dr. Nicholas Hellmann, vice president for clinical research at ViroLogic, Inc., of South San Francisco, Calif., "and one of them is that when you treat people with drugs you will develop resistance virus."

One fear, said Hellmann, whose company produces tests for resistance mutations in viruses, has been inappropriate treatment would create a superbug -- an "Andromeda strain" virus which could have human species-threatening potential.

Unlike bacteria, which appear to become tougher and more deadly as they gain resistance to antibiotics, Hellmann said, resistant viruses -- created by treating people with sequential drugs -- have failed to evolve into super-viruses. In fact, he said some of the resistant HIV-strains do not appear to be as virulent as the natural or "wild-type" HIV.

"The underdeveloped countries are going to benefit from our mistakes," Dr. Vella said. "They won't be treated with suboptimal regimens. They will receive simplified treatments so that compliance with not be an issue."

Even in countries where the medical infrastructure is marginal, sophisticated anti-retroviral therapy -- HIV is a type of virus called a retrovirus -- still can be delivered, said Dr. Eve Lackritz, chief of the AIDS treatment and care program at the National Center for HIV, sexually transmitted diseases and tuberculosis prevention of the Centers for Disease Control and Prevention in Atlanta.

Lackritz told UPI that "directly observed therapy" in small villages -- in which people receive drugs at one site on a daily basis -- could eliminate another problem of treatment in poor countries: Lack of regular access to care or diversion of drugs to illicit markets.

"We know that these drugs work," Lackritz said. "We know that if the patient takes the drugs, they will do well."

Hellmann added, even in a worst-case scenario, "if there is development of resistance to some of the drugs in Africa or Asia, it isn't going to be the end of the world -- literally or figuratively."
020711
UP020718

Always watch for outdated information. This article first appeared in 2002. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2002. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .