Tag: AIDS/HIV

Study Suggests Cheaper, More Effect Method to Prevent HIV Transmission to Newborns

Researchers at John Hopkins University and Makarere University in Kampala, Uganda, recently reported in the Lancet on the results of their tests of an alternative treatment to prevent children born to HIV-infected mothers from contracting the disease themselves.

Typically, AZT is used to reduce the risk of transmission. Unfortunately, AZT treatment has two drawbacks. First, it has to be given numerous times — the mother receives AZT every three hours during labor and then the infant receives it every day for a week after childbirth. Secondly, the need for numerous doses raises the cost of the treatment.

The John Hopkins and Makarere University researchers tested a much simpler regimen involving anti-HIV drug nevirapine. In the study, a control group was administered the AZT therapy and the experimental group was given nevirapine once to the mother during labor and then once to the infant immediately after birth.

The result was that the infants administered nevirapine were less likely to be HIV positive 18 months after birth than were those administered AZT. That represents a 41 percent lower risk for infants given nevirapine.

This confirmed results of a 1999 study, also in Uganda, in which infants and mothers were given either zidovudine or nevirapine. That study found that those receiving zidovudine were twice as likely to be HIV positive as those receiving nevirapine, though that study only tracked the infants several months after birth rather than the extended period of the latest study.

Johns Hopkins researcher Dr. J. Brooks Jackson said of the finding,

This use of nevirapine, if widely implemented, has the potential to prevent several hundred thousand new infections every year. This regimen is extremely simple, safe and inexpensive, but access to HIV testing and counseling remains a huge obstacle. Fortunately, the recent availability of funds for HIV prevention and treatment for Africa from the Bush AIDS relief plan will likely make a huge difference in the implementation of this nevirapine regimen.

Sources:

Article: Newer HIV Drug Protects Babies Better Against Virus. Reuters Health, September 13, 2003.

Cheap drug ‘prevents HIV births’. The BBC, September 12, 2003.

Drugs to Newborns Block HIV Infection from Moms. Kenna Brigham, Johns Hopkins University, October 13, 2003.

Finding a Way to Fight Mom/Baby HIV Transmission. Johns Hopkins University, September 15, 2003.

World Bank Report Warns of Impending Central & Eastern European AIDS Crises

The World Bank released a report in September highlighting the increasing rate of HIV infection in Central and Eastern Europe, and warned that if governments there do not do more to deal with the problem, it could turn into a catastrophe for that part of the world.

The World Bank estimates that 1.2 million people in Central and Eastern Europe are currently infected with HIV, and that number is growing by as much as 25 percent annually. About a quarter million people in the region, for example, were infected with HIV in 2002. The total number of people infected with HIV in Central and Eastern Europe is expected to rise to 8 million by the end of the decade.

The World Bank warned that if that infection rate is not curtailed, it could have serious widespread effects. In a press release, the World Bank said,

An uncontrolled HIV/AIDS epidemic could have devastating consequences on health and development in ECA, the report warns. If the HIV epidemic becomes widespread among the working age groups in the region, annual economic growth rates could decline by 0.5 to 1.0 percent. The effects of this drop will be compounded by rising health expenditures, which could increase by 1-3 percent, with substantial impacts on the health budgets of poorer countries in the region. Furthermore, the dependency ratio (the ratio of non-economically active to economically active people) could rise, which would severely strain social protection systems.

Despite such warnings, some country’s in the region aren’t doing much to combat the AIDS epidemic. For example, Russia’s total spending on AIDS is less than 1 percent that of Great Britain, even though Russia has 20 times as many HIV infected individuals than Great Britain. Five hundred people a month die from AIDS-related causes in Russia, with that number projected to increase to as much as 20,000 per month by 2020.

Sources:

Europe’s looming Aids ‘catastrophe’. David Bamford, The BBC, September 16, 2003.

HIV / AIDS Epidemic in the ECA Region. World Bank, September 2003.

Averting AIDS Crises in Europe and Central Asia. Press Release, World Bank, September 16, 2003.

Do Africans Follow Anti-HIV Drug Regimen Better Than Americans?

One of the long-standing arguments against the use of anti-retrovirals to treat the AIDS crisis in Africa goes like this: African countries like the health infrastructure to ensure that patients will consistently take anti-HIV drugs (which, of course, have a number of side effects). This will create a situation, the theory goes, where few patients take the full set of drugs and likely give rise to more virulent, drug-resistant forms of HIV.

But a survey of African patients in Botswana, Senegal, South Africa and Uganda found that, in fact, HIV patients in those countries were more likely to stick to their regimen of AIDS drugs than were Americans.

On average, the survey reported that AIDS patients in those four countries take about 90 percent of the prescribed drugs. That ranks favorably with American AIDS patients who, in similar surveys, reported taking about 70 percent of their anti-HIV drugs.

Interestingly, there is also evidence that African patients are more truthful in reporting their compliance with the anti-HIV regimen than American patients. According to the New York Times’ report of the survey results,

Moreover, doctors say, most African patients are zealous about their regimens. They are also more truthful when estimating their adherence, said Dr. David Bangsberg, a professor of medicine at the University of California in San Francisco who has studied compliance patterns here and abroad.

On average, he said, American patients tell their doctors that they are doing 20 percentage points better than they really are — that is, a patient who says he takes 90 percent of his pills will, when tested with unannounced home pill counts or electronic pill-bottle caps, turn out to be taking 70 percent.

A study of 29 Ugandan patients found that, on average, they estimated that they were taking 93 percent of pills and proved to be taking 91 percent.

There are a number of possible reason for the difference, including that in African nations a number of people in the AIDS patient’s extended family may be contributing to help pay for the relatively expensive drugs, and that AIDS patients in Africa have a more immediate experience with numerous fatalities from the disease given the relatively high death rate from AIDS in Africa compared to the United States.

Sources:

Africans Outdo Americans in Following AIDS Therapy. Donald G. McNeil Jr., New York Times, September 3, 2003.

Indian Prime Minister Says Country Needs to Pay More Attention to HIV Crisis

Other than South Africa, no other country in the world has more people afflicted with HIV than India. Yet so far tackling the AIDS epidemic has not been a high priority in that country. At an AIDS conference featuring 1,000 policy makers and activists, Indian Prime Minister Atal Behari Vajpayee promised that would change.

AIDS is spreading rapidly in India. In 2001, the number of AIDS sufferers in the country was under 4 million. A report released in July by India’s National AIDS Control Organization estimated that at the end of 2002 there were 4.5 million people infected with HIV in India. According to NACO director Meenakshi Datta Ghosh,

HIV/AIDS in India is not only confined to high-risk groups and in cities, but is gradually spreading into rural areas and the general population.

Like other countries, however, educating people about AIDS has faced opposition from conservative and religious elements in India. India’s current government is strongly Hindu-nationalist and members of the government have spoken out against AIDS education efforts. For example, Indian Health minister Sushma Swaraj has gone on record as saying that AIDS education ads should not feature condoms. Instead, Swaraj prefers an program of abstinence-oriented education.

India also faces the same sort of problems that other developing nations have run into — its people are so poor they can’t afford anti-AIDS drugs. Indian pharmaceutical firms openly produce generic versions of anti-retroviral drugs, but even the locally produced drugs are still too expensive for the vast majority of Indian HIV sufferers.

Sources:

Vajpayee calls for more political courage against AIDS epidemic. Elizabeth Roche, Daily Times (Pakistan), July 27, 2003.

Aids threat alarms Indian PM. The BBC, July 26, 2003.

South Africa Reverses Course — Will Distributed Anti-HIV Drugs

South Africa’s cabinet met in a special session in August and decided to finally distributed anti-HIV drugs . . . after it finishes a “detailed operational plan” to handle the distribution of such drugs. The decision was announced to coincide with the conclusion of an AIDS conference in South Africa.

Currently less than 30,000 South Africans take anti-retroviral drugs, though the government’s own report suggested that close to 500,000 could benefit from the availability of the drugs.

South African AIDS activist Zakie Achmat preferred to take a cautious approach to the announcement, telling the BBC,

We will wait to see the actual operational plan before celebration. But for all of us living with HIV in South Africa, and our families, this is the first sign of hope.

This is quite a turnaround from the same government whose Health Minister, Manto Tshabalala-Msimang has recently taken to suggesting that rather than anti-retrovirals, what AIDS patients in South Africa need to do to boost their immune systems is consume large quantities the African sweet potato, hypoxis. The few studies of large scale consumption of hypoxis, however, suggest that if it had any effect at all it would likely be a deleterious one for people suffering from HIV.

Sources:

SA activists hail AIDS drug U-turn. The BBC, August 9, 2003.

S. Africa to distribute AIDS drugs. CNN, August 8, 2003.

AIDS In Africa

Earlier this month someone in South Africa leaked an unpublished government report on the anti-AIDS drugs. Although the South African government has refused to buy or distribute anti-AIDS drugs due to a host of objections, the leaked report estimated that making anti-AIDS drugs available could save the lives of as many as 1.7 million South Africans over the next seven years.

Although the report was completed in March, the South African government claimed that it was simply a first draft and that it is doing all it can to treat AIDS patients.

In the past, South African government officials have trotted out every excuse from the expense of the drugs to claims that they need to be tested more thoroughly before they could be used in South Africa.

Meanwhile, in a visit to Africa U.S. president George W. Bush promised $15 billion to fight AIDS in Africa which put pressure on European nations to contribute billions as well.

Speaking before the International Aids Society conference, Nelson Mandela said that Bush had “moved the debate from hundreds of millions of dollars to tens of billions of dollars.”

Sources:

SA Aids deaths report leaked. The BBC, July 14, 2003.

Can Africa handle AIDS drugs? Patrick Jackson, The BBC, July 15, 2003.

Recipe for Disaster. The Star (South Africa), July 17, 2003.

Mandela assails global injustice of AIDS crisis. Sarah Boseley and Rory Carroll, Sydney Morning Herald, July 15, 2003.