Important note: Information in this article was accurate in August 2002. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; August 19, 2002
Staff Medical Writer
However, in sub-Saharan Africa, where 70% of people infected with HIV live, access to such treatments is extremely limited. High cost, complicated procedures, combined with inadequate infrastructures for following up patients or capable of delivering medicines regularly partly explain this situation.
Moreover, efficacy of antiretroviral agents might not be the same for some HIV strains present in Africa. And not enough is yet known about the response to therapy (e.g., viral resistance, adverse effects), notably in patients in advanced stages of immune deficiency.
These factors are considered obstacles to mounting concerted therapy programs in Africa. For some government authorities they provide the arguments for concentrating control campaigns solely on prevention with no involvement of antiretroviral drugs.
Since 1998 the Senegalese government has been developing a program facilitating access to AIDS treatments. Within this, an assessment program, coordinated by the IRD and the Senegal National Committee for AIDS Control, and financed by the Agence Nationale de Recherches Sur Le Sida (ANRS), has been deployed aiming to determine the effectiveness, the tolerance, the acceptability and feasibility of the standard form of antiretroviral therapy.
This study was conducted in a cohort of 58 patients between 16 and 56 years, having high viral load and low CD4 cell count. Most of them (86.2%) had developed the disease before the start of the antiretroviral therapy. All received a combination treatment of two nucleoside reverse transcriptase inhibitors plus one protease inhibitor. The drugs were taken in three doses per day, just as in the industrialized countries.
A sociological survey done in parallel assessed patients' ability to contribute to part of the cost of the treatment depending on their financial resources. The rest would be subsidized by the program.
At the end of the 18-month study, the results were comparable with those obtained in the countries of the North. Most patients (87.9%) regularly followed the course of treatment over the whole period monitored. Also, contrary to prior assumptions, financial difficulties did not hinder adherence to the therapy.
Furthermore, the same therapeutic efficacy was observed here as in the industrialized countries. After a year and a half of treatment the viral load was almost undetectable (below 500 copies/ml) in 59.3% of cases and the CD4 cell count had risen markedly (about 180/mm3). Tolerance to antiretroviral medicines was generally good, adverse effects observed being only mild. Only two cases of viral resistance to the drugs were found (Laurent C, Diakhate N, Gueye NFN, et al., The Senegalese government's highly active antiretroviral therapy initiative: An 18-month follow-up study. AIDS 2002 Jul 5;16(10):1363-70).
This study provided proof that the therapeutic strategies developed in the industrialized countries can also be applied in Africa. The Senegalese initiative shows that this tritherapy method proves to be effective for most patients, even if their immunity deficiency is severe before embarking on antiretroviral treatments - and although many different strains of HIV-1 are circulating.
It must be emphasized also that, contrary to results of several other studies conducted in Africa, viral resistance was rare. The researchers consider that the quality of follow-up of patients under the therapy regimens - attained by involving social workers - and the regularity of medicine supply, contributed to the effectiveness.
Judging by the excellent results obtained during this pilot phase, it now remains to ascertain that antiretroviral therapy maintains its efficacy over the long term and on a larger scale.
This article was prepared by AIDS Weekly editors from staff and other reports.
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