Treatment of AIDS

Treatment of AIDS

On average a patient with the HIV virus can live a normal life for 10-11 years without treatment. A cocktail of drugs known as antiretroviral therapy (ART) should commence when the strength of the immune system (known as the CD4 count) falls to a defined threshold.

The virus is not eliminated by ART but the risk of onset of Acquired Immune Deficiency Syndrome (marked by the establishment of one of a range of serious illnesses associated with immune deficiency) is reduced by about 80% giving the prospect of a reasonably normal lifespan.

Such is the position for people living with HIV in rich countries. In poor countries the patient may be unaware that he or she is HIV positive, there may be no available test for the CD4 count, there may be no government funds to pay for the treatment and health workers may lack skills to prescribe and monitor antiretrovirals. The CD4 threshold may be set lower than in rich countries exposing the patient to greater risk.

Other obstacles include the complexities of tuberculosis, often dormant in people living with HIV but liable to be activated by the virus. Circumstances of poverty and malnutrition conspire against the discipline of lifelong uninterrupted observance of the prescription. Drop-out rates of 62% after just 2 years have been reported in a UNAIDS survey of 13 developing countries.

Annie Kaseketi Mwaba, an HIV positive pastor in Zambia © Centre for Development and Population Activities

By the end of 2008, 4.0 million people living with HIV were receiving treatment in low and middle income countries out of 9.5 million in need. Although far behind the 2010 target for universal treatment, this figure has increased tenfold in just five years. Sub-Saharan Africa has kept pace such that its 48% treatment rate exceeds the global average. Nearly all poor countries now offer free testing for HIV at public heath centres.

Prospects for continued rapid progress are very sensitive to the price of antiretroviral drugs. This is a constant source of tension between the humanitarian anxiety to save lives and the return on capital sought by multinational pharmaceutical companies armed with 20 year patent protection.

Although World Trade Organisation (WTO) rules permit the least developed countries (LDCs) to acquire or manufacture low cost generics until 2016, middle income countries such as India, Thailand and Brazil depend on less concrete concessions in WTO rules for health emergencies. Painful lessons about equitable distribution of drugs may prove invaluable if the daunting problems associated with finding a vaccine for HIV are eventually overcome.