PartnersGF - 2004-07-14
IAC 2004: Scaling up access to treatment
Tuesday morning plenary session
HDN Key Correspondents Team
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Today's Quote
"As part of my efforts to help in the fight against AIDSD, I have dedicated my energy to working on developing HIV/AIDS messages through the media in order to reach out to as many people as possible."
Richard Gere
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Weve failed to do enough in the precious years since Barcelona 3 x 5 is our best chance.
A clear and rapid technical update on antiretroviral therapy opened the plenary, as stragglers held up by security checks arrived in the hall. Although the update was too technical for much of the audience, health-care providers were seen nodding their heads and rapidly taking notes on new developments. There are fifteen drugs that are commonly used worldwide, but most of the studies presented by Dr Kiat Ruxrungtham of Thailand featured the five antiretrovirals that will soon be available to millions who live in countries that follow the 3 x 5 recommendations.
The plenary update also included information on new studies that will be presented at this conference. What medications need to be taken by people who have been taking just two drugs? Double therapy is still very common in the developing world. When these two drugs start to fail and people living with HIV want to upgrade to three drugs, there is now good news. A simple twice-a-day regimen of efavirenz and ritonavir boosted indinavir is life-saving.
More new information followed. Dr Kiat noted that the 3 x 5 recommended drug stavudine is just as effective as the more expensive tenofovir when used in common combinations. And switching nevirapine from efavirenz is as simple as changing drugs. When efavirenz is given with the common TB medication rifampicin, no dose adjustments are needed. He also stressed adherence and put the responsibility for adherence on the shoulders of both patients and health-care providers. The relationship between the two is vital.
Dr Papa Salif of Senegal gave a clear summary of how TB programmes can improve care for people living with HIV and, on the other side of the coin, how AIDS programmes can improve care for people with tuberculosis. In HIV testing and counselling settings, up to a third of patients who are asked if they have had a cough have been found to have pulmonary tuberculosis. This simple verbal technology costs little. Dr Salif also recommended that all people who are found to have TB be offered HIV testing and counselling.
He also stressed the use of cotrimoxazole prophylaxis, used increasingly for positive people in Africa since it was first found to halve mortality five years ago. It is especially important for people with pulmonary tuberculosis but is also helpful for people without TB. This life-extending therapy is not often used in Asia, though activists are leading the way in recommending it. Although the impact of ART in reducing the incidence of tuberculosis has been proven in several studies in Africa, it has not yet been studied in Asia.
A short polemic from President Jacques Chirac delivered by a representative of the French government was noisily greeted by a protest by ACT UP Paris. The protesters observed the IAC freedom of expression rule, however, and their much-applauded banner AIDS G8 MUST PAY was carried away after a few minutes and the programme continued.
Dr Diane Havlir from the US gave an update on opportunistic infections. She presented a synopsis of the wide range of opportunistic infections in both Africa and Asia and noted the differences and similarities. She then went on to say that three co-infections are having profound effects on the epidemic. Tuberculosis, malaria, and sexually transmitted infections need action. All three can occur whether a person with HIV has a strong or weak immune system. Genital herpes virus infections have long been known to increase HIV transmission in Africa, and this is being increasingly recognised in Asia. Studies are ongoing to determine if the suppression of genital herpes will decrease transmission.
Dr Havlir pointed out the complex relationship between HIV and malaria and difficult treatment challenges for people with HIV. Malaria is more common and more severe among people with HIV. Pregnant women with HIV need antimalarial treatment. Cotrimoxazole prophylaxis will decrease malaria episodes and severity. But will cotrimoxazole lead to drug resistance for the most commonly used drugs used for malaria in Africa? Or will Africa have to begin to use Asias miracle malaria drug artemisinin?
Prefacing her take-home points with: Implement antiretroviral therapy it is the best prophylaxis Dr Havlir suggested that care services for tuberculosis, malaria, and sexually transmitted infections are efficient points of entry for ART. She also recommended cotrimoxazole prophylaxis!
Dr Jim Yong Kim of WHO was humble and honest. Weve failed to do enough in the precious years since Barcelona. This was met by embarrassed applause. 3 x 5 is our best chance.
We were reminded that the movement for access to treatment began with activists, many of whom were named personally by WHOs Director of HIV/AIDS. He also named the organisations that had played a part. Most of them were non-governmental. His recognition will encourage more activist working in kitchens and lean-tos with very little funding to continue to hold governments, multilaterals, and bilaterals accountable for their commitments.
In a previous satellite session before the official opening, Dr Kim has described what he called an ethical roll out as testing and counselling are scaled up. Consent, confidentiality, and counselling are needed for all HIV testing. Meeting the ethical imperative of treating all people who need care will be demanded by communities of people living with the virus and their caregivers.
HDN Key Correspondents Team
Email: correspondents@hdnet.org