Drug access won't slow HIV rates in poor countries

Tue Mar 21, 2006

NEW YORK (Reuters Health) - Widespread access to antiretroviral therapy (ART) for HIV infection will probably have little impact on the spread of the virus in developing countries, new research suggests. In fact, in the current estimates, providing unlimited ART to AIDS patients actually increased the number of infected individuals.

As reported in the journal PLoS Medicine, Dr. Rebecca F. Baggaley, and colleagues from Imperial College London, constructed a mathematical model of HIV spread in developing countries that incorporated ART use and stratified infection by stages. In addition, the impact of ART was assessed in the context of various scenarios, such as the provision of laboratories to measure CD4+ cell counts and viral load, two tests that gauge the progression of HIV infection.

The researchers assumed that ART consisted of a standard three-drug regimen, with no "salvage" therapy available for those who experienced treatment failure. They also assumed that all sexual intercourse was heterosexual and that risk-taking behavior changed among some HIV-infected patients upon initiating ART.

Based on these and other parameters, the analysis showed that regardless of availability, the use of ART for AIDS patients had little impact on averting infections.

By contrast, the widespread coverage of ART for HIV-infected patients who have not progressed to AIDS did seem to avert HIV infections, but the absolute magnitude of this effect was small, the report indicates.

For all HIV-infected patients, increasing ART availability was associated with increases in drug resistance, the authors report.

"Our analysis found that ART cannot be seen as a direct transmission prevention measure, regardless of the degree of coverage," the researchers write. "Counseling of patients to promote safe sexual practices is essential and must aim to effect long-term change."

SOURCE: PLoS Medicine, April 2006.

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