TREATMENTS AND COSTS OF HIV

"HIV is the biggest health crisis since the 14th century. Despite this fact, AIDS vaccines account for less than 1% of global spending on health- and pharmaceutical-related research and development. "

According to the International AIDS Vaccine Research, from the first case recorded in June 1981 through the end of 2001, 25 million people have died of AIDS. Even if there are powerful medicines now available to treat HIV infection, these drugs are not cures, and they remain out of the reach of most of those who could benefit from them. "We all know that the availability of a biomedical option does not necessarily guarantee access and use by the people who need it most". ??? An estimate of both, those who have died and those currently living with the virus in the past 20 years brings the total to 65 million people.

• Treatments taken by patients

There are two major groups of medications taken by HIV patients: antiviral drugs and treatments for specific opportunistic infections. Research in the field of AIDS medication is going on at an intense rate. Many drug companies are researching new products, and researchers expect that great advances will take place in the next few years.

Antiviral medications: HIV is a retrovirus. After it has entered the body, it infects and takes control of CD4 cells (white blood cells). By infecting these cells, it combines its genetic material with that of the cell, and becomes bound to it as one unit. The cell then becomes a factory for producing more HIV. Reverse transcriptase? allows the virus to change its RNA into viral DNA that can be used by the host cell. There are different types of antiviral drugs, which work by interfering in, different ways, with the process of infecting cells and reproducing more HIV. The most common antiviral drugs for HIV are reverse transcriptase inhibitors. Some of these are nucleoside analogs, which look very much like the viruses' genetic material but are different enough to interfere with viral replication. They do this by using "defective building blocks". The virus uses these blocks unknowingly to replicate its self. By using these "defective" parts, the virus's replication process stops.

These HIV drugs are categorized as very strong medications, and their side effects may make them difficult for some people to take. Reverse transciptase inhibitors do not eliminate the virus from the body, and so they do not cure the infection.

A newer class of drugs called protease inhibitors also interferes with the replication process. They work at the final stage of viral assembly. This takes place after the virus is inside the CD4 cell and is ready to begin production of new viruses. It prevents new viruses from assembling inside infected cells.

Today, the most successful drug therapyplans? combine medications in a multi-drug approach. This strategy is called HAART, which stands for "highly active anti-retroviral therapy." In the popular press, the combination is sometimes called a "drug cocktail." Individual drugs attack the virus in a slightly different way, so doctors have learned to apply a multi-front attack all at once. The most widely used nucleoside analog antiviral drugs are AZT (also called zidovudine or Retrovir), ddI (didanosine or Videx), d4T, and 3TC. It's not known how long the drugs will be effective. It is hoped that the drugs may eventually be able to eradicate the virus from the body.

Opportunistic Infection medications: Drugs used to prevent or delay opportunistic infections are prescribed for use at different times. They are used for prophylaxis, or prevention, and treatment. They can also be used to prevent a second repeated infection. Those who die of AIDS actually die from one or more of these opportunistic infections. The HIV virus is not directly responsible for causing lethal infections that may lead to death. It just weakens the person's immune system.

• Latest scientific news

A major scientific goal has been to slow or stop the spread of the virus. Although we are not there yet, some progress has been made and several encouraging developments have taken place over the past several years. There has been significant progress in the understanding of the structure of the HIV envelope and the types of antibody responses likely to neutralize HIV in vivo?. Although there is still considerable debate about the mechanisms of protective immunity, there is now an emerging consensus that a successful AIDS vaccine should be able to induce both CTL and antibody responses able to neutralize primary viral isolates. At present, in the absence of definitive information about the mechanisms of protective immunity, induction of these responses remains an initial benchmark by which to judge candidate AIDS vaccines. Several approaches, notably vaccination with DNA and attenuated poxviruses, have been able to induce virus-specific CTL in nonhuman primates and, in combination with booster immunization with recombinant subunit vaccines, are able to induce neutralizing antibodies against TCLA viruses. Extensive research of these vaccines is now in progress in nonhuman primates. The National Institutes of Health have recently embarked on an expanded effort to accelerate AIDS vaccine development, which has emphasized development of novel vaccine approaches. Despite these encouraging advances, considerable challenges remain and substantial progress must still be made to develop a safe and effective AIDS vaccine.

• Costs induced to cure Africa

Recently researchers have tried to determine the financial costs that would be required to make a real difference to the AIDS epidemic in Africa. The research points out that not only is it imperative to scale up the response to Africa's epidemic, but also that such an undertaking is, in fact, affordable.

US$1.5 billion a year would make it possible to achieve massively higher levels of implementation of all the major components of successful prevention programmes for the whole of sub-Saharan Africa. These would cover sexual, mother-to-child and transfusion-related HIV transmissiond, and would involve approaches ranging from awareness campaigns through the media to voluntary HIV counseling and testing, and the promotion and supply of condoms.

In the area of care for orphans and for people living with HIV or AIDS, costs depend very much on what kind of care is being provided. It is estimated that, with at least US$1.5 billion a year, countries in sub-Saharan Africa could buy symptom and pain relief ?(palliative care) for at least half of AIDS patients in need of it; treatment and prophylaxis for opportunistic infections for a somewhat smaller proportion; and care for AIDS orphans. Currently, the coverage of care in many African countries is negligible, and so reaching the levels of the above mentioned coverage would be an enormous step forward.

Making a start on coverage with combination anti-retroviral therapy would add several billion dollars annually to the bill.
Of course, providing AIDS prevention and care services involves more than just these funds. A country's health, education, communications and other infrastructures have to be well developed enough to be able to deliver these interventions. In some badly affected countries, these systems are already under strain, and they are likely to crumble further under the weight of AIDS. Then, too, money can only be used wisely if there are sufficient people available and the shortage of trained men, women and young is already acute. ????
(source:These figures are estimates at the end of 2001, published by UNAIDS in the "Report on the Global HIV/AIDS Epidemic, July 2002")

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