AIDS leaders call for more world support

Over 12 million in developing world could still benefit from treatment

by Bob Roehr

Medical leaders of the International AIDS Society, meeting in Cape Town, South Africa, chastised political leaders of the developed world for inadequate support of AIDS programs in the developing world. They called for more money and greater financial concessions from the pharmaceutical industry.

IAS president Julio Montaner said the leaders of the eight wealthiest countries (GS) pledged in 2005 to fight for universal access to AIDS treatments by 2010, but at their meeting this month in Italy, they didn't even mention the word AIDS.

"The silence of the G8 leaders is not just pathetic, it is criminal," said Dr. Montaner, who runs AIDS programs in the province of British Columbia, Canada.

More than 3 million people in the developing world have started antiretroviral therapy over the last four years but 12 million people could benefit from those drugs. Some treatment programs have declined to start more patients on treatment because they cannot guarantee continued access to those drugs.

The group Medecins San Frontieres - in English, Doctors Without Borders - released a report saying that stagnating donations and the high cost of second-generation drugs "are putting the lives of thousands of poor patients at risk" every day.

The World Health Organization recommended in 2006 that an initial therapy should be based upon the drug tenofovir. But most patients in the developing world are on stavudine (d4t), an older drug that costs about half the price of tenofovir.

However, HIV more readily mutates resistance to stavudine, and it is associated with the side effects of disfiguring lipodystrophy and painful peripheral neuropathy. That is why few patients in the U.S. and Europe continue to use stavudine.

MSF urged pharmaceutical companies to deposit their drug patents into a "patent pool" that generic manufacturers might use under set licensing terms, with the freedom to create pills that combine several drugs as they see fit. The patent holders have been cool to the idea.

The MSF report also called for development of a simple, rapid, inexpensive diagnostic to measures HIV viral load in developing countries. Many groups have tried to create such a tool but with limited success. Monitoring of viral load is standard practice in the US but rare in the developing world.

As a result, patient there stay on a failing regimen longer, until they develop clinical symptoms of that failure, such as an opportunistic infection. That results in greater and often irreversible damage to their immune systems. It allows the virus to develop resistance to other drugs in the combination that might not yet have failed.

Gregg Gonsalves, with the International Treatment Preparedness Coalition, said, "The MSF report puts the focus back on real people living with HIV disease and warns us that saving millions of lives depends on a renewed push for universal access to antiretroviral therapy, which will require significant new investments in global health."

The HIV Vaccines and Microbicides Resource Tracking Working Group, a coalition of several organizations, released a report showing that in 2008, for the first time, there was a decline in spending on the search for a vaccine for HIV.

The decline was primarily because two major vaccine trials were halted early, in late 2007, because of poor results and those allocated funds were not spent. It noted that only 4 percent of HIV vaccine research funding is coming from the private sector, with the vast majority coming from government and foundations. The NIH is the largest single funder of HIV vaccine research.

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