Advertisement

U.N. moves toward quicker AIDS treatment in developing countries

Share

The United Nations’ agency in charge of AIDS policy is lowering the threshold for treating HIV-positive individuals in developing countries in the hope that earlier treatment will prevent hospitalizations and reduce related medical care costs, the organization said Tuesday.

The announcement is part of a new report issued in advance of next week’s international AIDS conference in Vienna, the biennial meeting at which researchers present the most recent AIDS research and policy decisions

The agency currently requires that a patient’s CD4 level, a measure of the severity of infection, fall below 200 cells per cubic millimeter before treatment is begun, but at that level patients often already have some AIDS symptoms. The agency will now allow treatment to begin once the level has fallen to 350, at which point the patient is still relatively healthy. Normal levels are 500 or higher.

The agency is also developing a new therapeutic regimen, called Treatment 2.0, that will rely more heavily on combinations of drugs, rather than single drugs, as first-line therapy to block the progression of infections. It also will incorporate new, less expensive diagnostic tests to monitor infection levels and the progress of therapy.

“We expect there might be a relatively minor increase in the need for additional funding … but the resource needs for treatment will be lower over the next decade,” Dr. Bernhard Schwartlander, UNAIDS’ director for evidence strategy and results, said at a news conference. “Today, the majority of patients come to clinics when they are very, very sick. It’s much, much cheaper and simpler to treat them before they get sick.”

The new treatment regimen is also expected to reduce new infections because patients with their infections under control by medication are much less likely to transmit the virus to sexual partners.

The agency estimates that implementation of the program could prevent 10 million deaths and avert 1 million new infections by 2025.

The rationale for the new approach is that the secondary costs of HIV treatment, including hospitalizations, monitoring and out-of-pocket expenses, are now twice as high as the cost of the drugs themselves. But implementing the approach will take time.

Many existing drugs could be used in the program, Schwartlander said, but they would need to be combined into a single pill. That will require additional clinical trials and assessments of dose optimization, which could take the rest of the year, at least.

New, simpler tests for monitoring HIV levels and overall health in patients are also becoming available, and UNAIDS is working with manufacturers to hasten their arrival, he said. “We expect to have the first products on the market for monitoring CD4 levels by the end of the year and for viral load testing by next year,” he said.

An estimated 33 million people worldwide are living with HIV infections. About 2.7 million people are newly infected each year and an estimated 2 million die from AIDS and its complications.

About 5 million people in developing countries are receiving HIV medications, “a twelvefold increase in the past six years and up from almost nothing in 2002,” Schwartlander said. But an additional 10 million are in need of therapy. To reach them in the immediate future will require boosting funding by about $10 billion from the current level of about $16 billion per year.

UNAIDS is urging individual countries in Africa and elsewhere to contribute 0.5% to 3% of their government revenue to national HIV programs, Dr. Paul De Lay, deputy executive director of the UNAIDS program branch, said at the news conference. Even so, he added, “the majority of the most affected countries will continue to rely primarily on international assistance.”

One piece of good news in the report is that the infection rate among young people in the most severely affected countries is falling. Among 15 of those countries, the prevalence of HIV among young people — the target group for most prevention campaigns — has fallen 25%.

“Young people are adopting safer sexual behaviors, including delaying their sexual debut, having fewer partners and using more condoms,” De Lay said.

thomas.maugh@latimes.com

Advertisement