HIV treatment access improves, but coverage low

Mon Jun 2, 2008 1:17pm EDT

NEW YORK (Reuters Health) - As of the end of 2007, close to 3 million HIV-infected individuals in low- and middle-income nations had access to antiretroviral drug therapy (ART), representing an increase of nearly 950,000 people who received ART last year.

This reflects a 7-fold increase in treatment access over a 4-year period, which was spurred on by the "3 by 5" initiative proposed by the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) in 2003 to have "3 million HIV-infected people on treatment by 2005." Although not achieved in the proposed time frame, it accelerated the global effort to get ART to low- and middle-income countries.

Despite these important gains, nearly 2.5 million new HIV infections occurred during in 2007 and 2.1 million died of AIDS, according to a report released today by the WHO, UNAIDS and the United Nations Children's Fund (UNICEF).

Moreover, treatment need still outpaces availability, with the majority of HIV-infected people in low- and middle-income nations who need treatment -- approximately 69 percent -- still not receiving treatment.

"Treatment doesn't close down the epidemic," Dr. Kevin M. De Cock, Director, HIV/AIDS Department at WHO, cautioned during a teleconference that coincided with the release of the report. "More investment in prevention is needed while scaling up treatment."

Progress has also been made in increasing access to ART regimens for pregnant women to prevent transmission of the virus to their child, in making testing and counseling more available, and in supporting male circumcision, which reduces HIV transmission risk, in sub-Saharan Africa , according to the annual report.

Reductions in the cost of first-line ART drugs were an important factor in making treatment feasible; drug costs declined by 30 percent to 64 percent between 2004 and 2007 in low- and middle-income countries. However, the costs of second-line ART, drug regimens used when initial treatment begins to fail, still remain beyond the reach for most in these countries. Prices are also high in a number of Latin American and Eastern European countries.

Among HIV-positive individuals in low- and middle-income countries who are on stable ART regimens, morbidity and mortality rates can approach those seen in high-income countries.

Nevertheless, the overall HIV/AIDS mortality in countries to the south remains significantly higher than mortality seen in countries in the north, Dr. De Cock noted.

This is partly explained by the fact that HIV-infected people in low- and middle-income countries are usually diagnosed very late in the course of infection, he said. Some patients are diagnosed and then don't receive ART. In other cases, once patients are stabilized on maintenance ART, they are lost to follow-up. These are important areas, he added, that require more attention.

However, a large majority of HIV-infected individuals have still not been diagnosed, the report confirmed. The results of a survey of 17 countries reveal that only an average of about 11 percent of women and 10 percent of men had ever been tested for HIV and knew their results. In another 12 countries, an average of 20 percent of people living with HIV/AIDS were aware they were infected.

The vast majority of HIV infections worldwide -- 80 percent -- are still transmitted sexually. Approximately 10 percent of new infections are transmitted by injecting drugs. While sex remains the primary route of transmission in sub-Saharan Africa, injecting drugs is the most common route of HIV transmission in more than 80 percent of the new cases in countries in Eastern Europe and Central Asia .

The largest population of individuals living with HIV in high-income countries is men who have sex with men.

Progress has been made in increasing treatment to prevent maternal-infant transmission. Compared with 2004, when 10 percent of pregnant women with HIV were on ART to prevent vertical transmission, by 2007, the rates rose to 33 percent. Ten percent of pregnant women were tested for HIV in 2005, while testing rates rose to 18 percent by last year.

A lack of sustainable funding is a problem, with the gap between available and needed funds for programs to achieve universal access to treatment and prevention of HIV infection running at about $8.1 billion US.

The lack of a fully functional health care infrastructure also remains a barrier to treatment in many countries, as does a shortage of health care workers. "Brain drain" is a problem, with many health care professionals seeking better positions in other countries. HIV/AIDS mortality has also reduced the number of available health care workers and other professionals in many countries, especially in sub-Saharan Africa.

Australian researchers say 'natural condom' could stop HIV

Longer drug therapy helps babies ward off AIDS

04 Jun 2008 21:00:20 GMT

By Gene Emery

BOSTON , June 4 (Reuters) - Three months of extra treatment with the drug nevirapine helps babies ward off the AIDS virus longer, and infected women do not need to rush to wean their infants, researchers reported on Wednesday.

Separate studies in two African nations address a pressing problem in developing countries, where 200,000 children each year pick up HIV through their mother's breast milk.

Doctors are seeking the least expensive way to protect the babies from HIV while trying to not discourage breast-feeding, which prevents other diseases.

A study of thousands of newborns in Malawi found that adding 14 weeks of treatment with nevirapine to the standard therapy -- one dose of nevirapine plus a week of treatment with AZT or zidovudine -- halved the infection rate at 9 months to 5.2 percent.

Nevirapine is sold under the brand name Viramune by privately held Boehringer Ingelheim.

Giving nevirapine plus AZT for 14 weeks offered no additional benefit, and may have produced more side effects, they reported in the New England Journal of Medicine.

In the second study, designed to see if quickly weaning babies produced fewer infant AIDS cases, a team led by Dr. Louise Kuhn of Columbia University found little benefit.

They studied 481 Zambian babies whose mothers had been encouraged to abruptly wean them at 4 months. Just over 68 percent of the babies were uninfected at 2 years.

Among 477 Zambian women who were encouraged to breast-feed as long as they wanted, the virus-free survival rate was about the same -- 64 percent.

WEANING AND DEATH

But among babies already infected by the age of 4 months, encouraging their mothers to stop breast-feeding dramatically increased their risk of death. Nearly 74 percent had died before their second birthday, compared to a 55 percent death rate among the babies whose mothers had been told to keep nursing.

Preliminary results from this study prompted the World Health Organization to change its breast-feeding recommendations for women in developing countries.

"The Zambia study showed that there was really no benefit to stopping breast-feeding early at 4 months. So breast-feeding is better than not breast-feeding," said Lynne Mofenson of the National Institute of Child Health and Human Development, the project officer for both studies.

"But breast-feeding brings along with it the problem of HIV transmission, and what the Malawi study is showing for the first time is if you give the baby small amounts of anti-HIV drugs for the first 14 weeks of life, you can reduce the risk of HIV infection at 9 months by 50 percent or more," she said in a telephone interview.

"Those two things say you should exclusively breast-feed the baby and you should give the baby antiretroviral drugs for at least 14 weeks."

The institute is now looking at whether longer drug treatment will be even more beneficial.

"Right now it's estimated that under 20 percent of HIV-infected women are receiving any prophylaxis to prevent mother-to-child transmission, so we're having difficulty implementing even the single-dose nevirapine regimen. However, things are changing relatively rapidly," Mofenson said. "Four years ago it was only 7 percent." (Editing by Maggie Fox and Xavier Briand)

SOUTH AFRICA : HIV a factor behind obesity?

04 Jun 2008 17:11:22 GMT

Source: IRIN

Reuters and AlertNet are not responsible for the content of this article or for any external internet sites. The views expressed are the author's alone.

CAPE TOWN , 4 June 2008  - While public health experts in South Africa spent much of the last decade focusing on controlling infectious diseases such as HIV/AIDS and eradicating malnutrition, the growth of another public health crisis has gone almost unnoticed.

High obesity levels, which have given rise to a virtual epidemic of non-communicable diseases like diabetes and hypertension, are finally grabbing attention.

Being overweight brings with it serious health risks: obesity usually comes first, followed by hypertension (high blood pressure) as the heart has to work much harder to pump blood to all parts of the body. Health officials have warned that if these are accompanied by an unhealthy diet, lack of exercise and smoking, it can also result in heart disease and diabetes.

Women are more at risk, with 56 percent falling into the overweight category, and black, urban women the most likely to be overweight, according to a 1998 Demographic and Health Survey.

Researcher and dietician Tandi Matoti-Mvalo believes diet is not the only factor behind South Africa 's growing weight problem. "In South Africa , women are not keen to lose weight because of associations of thinness with HIV," she told delegates at the 4th Public Health Association of South Africa conference in Cape Town this week.

In the results of a study among women living in Khayelitsha, a black township outside Cape Town , Matoti-Mvalo found that although most participants were overweight, they did not consider this unhealthy; in fact, a third preferred it.

When they were shown pictures of eight women ranging from thin to obese, most participants selected the overweight or obese women as representing their body image ideal; the thin women were strongly linked with HIV and AIDS.

"Much effort has gone into teaching people about HIV and AIDS, but most women in this study still believe you could tell if someone had HIV just by looking at them," Matoti-Mvalo commented. Rather than risk the stigma associated with HIV, the women in the study preferred to be overweight.

She said health professionals working in such communities needed to be aware that not only were an unbalanced diet and lack of exercise major risk factors for obesity, but also cultural beliefs and attitudes. She recommended more education to counteract misconceptions about what constitutes a healthy body weight.

PHILIPPINES : Tuberculosis remains a major killer

04 Jun 2008 09:26:58 GMT

Source: IRIN

Reuters and AlertNet are not responsible for the content of this article or for any external internet sites. The views expressed are the author's alone.

MANILA, 4 June 2008 - Each of the dozen or so beds in an airy ward in Quezon Institute, in Metro Manila, a private hospital dedicated to fighting tuberculosis, has a story to tell.

Rosalinda Dunton, 71, wonders when she can go back home to Capiz Province . She has been confined for three weeks now, suffering from a complicated form of TB. Her granddaughter stayed with her throughout, but with school opening next week, nobody will be by her bedside daily.

Next door is 60-year-old Juanita Gello-Agan, who was rushed to hospital a few days before because her diabetes had been complicated by tuberculosis. A nurse has just handed George, her son, a new list of medicines. George told IRIN the combined effect of his unpaid leave to care for his mother and the cost of medicines was taking its toll on his family. "The impact on our finances is really big," he said.

A financial burden

The Quezon Institute is free, as are the TB medicines. But patients must pay for the other antibiotics and vitamins prescribed, and in each of the beds, the stories are similar - finances drained because of the costly drugs and lives temporarily put on hold because of the ravaging disease that still ranks number six among the leading causes of morbidity and mortality in the Philippines.

According to the World Health Organization (WHO), the country has the ninth highest number of tuberculosis cases in the world and the highest in southeast Asia. Globally, there were more than nine million new cases and about 1.7 million deaths from the disease in 2006; the WHO estimates there are more than 14 million people living with TB, which kills 75 Filipinos each day, according to the Department of Health.

But over the years, the government, with the private sector and humanitarian community, has steadily made gains against tuberculosis. The DOTS (Directly Observed Treatment Short-course) programme, recommended in the mid-1990s by the WHO, played an important role in this success. DOTS required patients to take their medicine in front of a health worker to ensure proper compliance with the entire treatment programme.

Before its implementation, patients often sold their free medication to other people once they started to feel better, Arnold Ortiz of the Philippine Tuberculosis Society, which runs Quezon, told IRIN. "Because of this poor compliance, patients develop multi-drug resistant tuberculosis," he said.

Early detection and surveillance

DOTS consists of improved case detection through strengthened laboratory testing and drug resistance surveillance, which, according to Maria Lorela Averilla, monitoring and evaluation officer of the government's National Tuberculosis Program, is key to fighting the disease. On infected person can infect many more if left untreated.

Because of the success of DOTS, Averilla told IRIN, the Philippines is one of the first four among the 22 "high burden" countries to have met the WHO's targets of a 70 percent detection rate and an 85 percent cure rate. The country's detection rate is 77 percent and its cure rate 89 percent. In 1990, there were 819 cases out of every 100,000 Filipinos; in 2006, this dropped to 432. Mortality rates fell too, from 80 per 100,000 in 1990 to 45 per 100,000 in 2006.

These gains, however, are mostly against regular pulmonary tuberculosis. Most challenging for health officials are new forms of multi-drug resistant tuberculosis and complicated cases in which the patient has other conditions, including diabetes and HIV/AIDS.

In fact, Ortiz said that because the government became aggressive in fighting tuberculosis, admission rates at the Quezon Institute for regular pulmonary tuberculosis dropped. The hospital trimmed bed capacity four years ago and focused on treating complicated tuberculosis cases.

Late diagnosis

"Most of the patients we lose are those who come in for treatment too late, who live in far-flung areas and don't have easy access to medical facilities and who do not comply with the treatment programmes given to them," Ortiz told IRIN. "These are the ones who develop complicated or multi-drug resistant tuberculosis," he said. "Despite all the efforts at raising awareness, ignorance about tuberculosis remains high and the stigma still associated with it keeps people from seeking treatment."

Averilla said that while multi-drug resistant tuberculosis used to be treated only at private hospitals, it is now being addressed in public health centres.

Policies have also been set in place to address TB acquired because of other diseases. But she adds that, first and foremost, people have to have health-seeking behaviour. "We have enough resources in public health centres to treat tuberculosis," she says. "People just have to come and avail themselves of them."

Vertex sells royalty stream from GlaxoSmithKline HIV drugs for $160 million

Tuesday June 3, 10:46 am ET