AIDS pandemic can be a chance to change societies

AFRICA NEWS

AIDS drugs: New study backs early approach
Doctors on Thursday published evidence backing calls for treating HIV-infected patients before their immune system crashes below a commonly-recognised threshold of damage inflicted by the AIDS virus. Highly active antiretroviral therapy (HAART) began to overturn the automatic death sentence associated with AIDS after this powerful cocktail of drugs was introduced in 1996. But a big question is when someone infected with the human immunodeficiency virus (HIV) should start to take the drugs. Physicians have to balance the benefits of restoring immune defences against the risk of the treatment's side effects, which can be toxic.

There is no universal guideline for when HAART should be administered, but a common recommendation is to start the drugs when there are fewer than 200-250 CD4 cells -- key immune cells that are attacked by the virus -- per microlitre of blood. Some researchers say this threshold is too low and lives can be saved if drugs are started sooner, although hard evidence to back this is sketchy. In a paper published in The Lancet on Thursday, a team led by Jonathan Sterne of Britain's University of Bristol compared studies that followed more than 45,000 HIV-infected people in Europe and North America before and after the HAART era.

Those who began HAART when their CD4 count was below 350 cells per microlitre were 28 per cent likelier to develop AIDS or die prematurely than those who grasped the lifeline when their CD4 tally was 351-450 cells per microlitre. The paper says these figures shift the pendulum in favour of starting treatment earlier, especially as new antiretrovirals have fewer side effects than before. "In view of diminished concerns about toxic effects and resistance, our results suggest that 350 cells per microlitre should be the minimum threshold at which antiretroviral therapy is started," it says. In a comment also published in the Lancet, South African AIDS specialists Robin Wood and Stephen Lawn cautioned against a one-size-fits-all recommendation.

Poor countries often have a limited range of HAART drugs available and have to make tough decisions about cost effectiveness, they said. "The question of when to start (HAART) might have more than one right answer," they argued. Last August, a panel of American doctors in the International AIDS Society (IAS) also spoke in favour of raising the threshold to 350 CD4 cells per microlitre or higher. The benefits from controlling HIV earlier include lower incidence of lung, anal, head and neck cancers, cardiovascular disease and kidney and liver dysfunction, they said.

by Staff Writers
Dakar (AFP) April 9, 2009
The HIV/AIDS pandemic, which has already killed an estimated 25 million people since the 1980s, is not only a problem but a social opportunity for change, according to new UNAIDS chief Michel Sibide.

The Malian is the first African to hold the post of the United Nations AIDS czar.

"People shouldn't see the epidemic as only a problem, like we have been doing up to now," Sidibe told AFP in an interview on a visit to Senegal three months after taking up his post.

"We have to ... try and show that the epidemic can be an opportunity. A political opportunity to trigger profound changes in society, to talk about difficult issues like sex education, homophobia and human rights issues in general like the position of women in society," Sidibe argued.

HIV/AIDS could be "an entry point to discuss these issues and bring about changes in legislation".

The financial resources available to combat HIV/AIDS can also help strengthen healthcare especially in Africa, the world's poorest continent and the most affected by the epidemic.

"Of the 25 billion dollars in aid estimated to be needed to finance universal access (to treatment for HIV/AIDS), nine billion dollars (6.8 billion euros) is earmarked for overhauling health care systems," he stressed.

"This is an opportunity if we make sure we don't isolate it like we have done for the past 20 years ... and only use it for HIV/AIDS," the 57-year-old who worked for the UN's children's organisation UNICEF for 14 years before joining UNAIDS in 2001, explained.

"It could be a way to transform and rebuild society around the social needs of the population," Sidibe added.

"I see UNAIDS as a political agent which has to demand change, I don't see it as UNICEF or the World Health Organisation which very clearly outlined programs."

"UNAIDS has to be the voice for the voiceless, it should have political courage," according to Sidibe. The organisation recently criticised the pope's stance on the use of condoms.

Ahead of a trip to Africa pope Benedict XVI said AIDS "cannot be overcome through the distribution of condoms, which even aggravates the problems."

The comments have sparked international criticism from governments, UN agencies and health groups.

During a meeting with Senegalese president Abdoulaye Wade, Sidibe said he had also raised the appeals case of nine men convicted to eight years in prison for homosexual acts.

"Universal access to care, treatment and prevention is my number one priority. The money is essential, we need to continue to mobilise resources and redouble our efforts to make sure the Global Fund is totally financed."

The Global Fund, set up to fight AIDS, malaria and tuberculosis in 2002, is still seeking 4 billion dollars in funding for the 2008-2010 period.

But rather than launch another call on international donors who are reeling from the effects of the global economic crisis Sidibe said UNAIDS should also think about how to optimize the partnership.

"We should make sure that we can demand a certain performance, with an accountability, and obligation to produce results" in the fight against HIV/AIDS, he stressed.

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EPIDEMICS

Toll in China disease outbreak rises to 31 children

Beijing (AFP) April 7, 2009
The death toll in China from a highly contagious disease which is especially dangerous for young children has risen to at least 31 so far this year, government and state media said Tuesday.

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