The vast majority of children with HIV/AIDS live in developing countries. Due to improved treatments, mother-to-child transmission is hardly seen anymore in wealthy countries. Therefore, investing in and producing antiretroviral drugs for children are not interesting for the pharmaceutical industry.
World AIDS Day 2004
Donor governments and countries hardest hit by HIV/AIDS must take immediate steps to address today's treatment deficit emergency and the gaps in research and development to fight the pandemic, the international medical humanitarian organization Médecins Sans Frontières urged in a briefing today.
MSF currently provides antiretroviral treatment to more than 23,000 people living with HIV/AIDS in 27 countries in Asia, Africa, Latin America and Eastern Europe. "MSF has succeeded in making a difference to our patients and their families, but we have not seen massive scale-up efforts in most of the countries we work in. Outside the few clinics offering ARVs, the treatment landscape is a desert.
The imperative to fund and manage treatment programmes is still being neglected," said Dr Rowan Gillies, president of MSF International. Out of the six million people needing antiretroviral treatment in developing countries, only 440,000 currently have access to it.
Yet several important lessons about expanding AIDS treatment have been learnt in MSF and other treatment programmes in the past few years enabling sharp increases in patient enrollment. First is the use of simplified treatment regimens.
"Although they are not the final answer to AIDS, triple drug cocktails literally allow people to rise from their deathbeds, and live normal, longer lives," said Dr Arnaud Jeannin from MSF's AIDS programme in Malawi.
More than 75% of new patients within all MSF projects start treatment on these affordable one-pill-twice-a-day formulations produced by generic companies. Clinical and biological results have been excellent with overall probability of survival at 85.3% after 24 months of treatment. Another significant factor leading to good treatment results is the programme design: MSF offers treatment free of charge, and provides support and education to help people take their medicines correctly and consistently.
This has led to adherence rates that rival or exceed those seen in the West, a factor considered essential in slowing the onset of resistance. Overall, the AIDS pandemic remains undefeated.
At today's briefing, MSF also highlighted the lack of paediatric formulations of antiretroviral medicines and the lack of reliable diagnostic tests to detect tuberculosis, the number one AIDS-related opportunistic infection, in HIV-positive individuals. "R&D efforts leading to practical advances in treating the poorest communities most affected by HIV/AIDS should be prioritized as part of a comprehensive response to AIDS," said Daniel Berman,
Coordinator of MSF's campaign for Access to Essential Medicines. MSF AIDS programmes are run in diverse settings ranging from hospitals in the capitals to city slums to remote rural areas. Activities include prevention efforts, voluntary testing and counseling, nutritional and psychosocial support and treatment of HIV and opportunistic infections.