Growing Threat of HIV Drug Resistance Poses Questions for Treatment in Africa, Washington Times Reports

Antiretroviral drug regimens are failing "in an alarming number" of HIV/AIDS patients in the United States, raising questions about the feasibility of administering AIDS drugs in sub-Saharan African countries, the Washington Times reported yesterday in a front page special report. Drug regimens that once "produced remarkable recoveries," allowing HIV-positive individuals to "return to relative health and a normal life," are failing in as many as half the patients taking them. While the treatments have contributed to a decline in AIDS-related deaths in the United States, doctors believe that the death rates will "creep back up" as the treatments continue to fail. In addition, the "toxic" treatments cause "severe" side effects, including high cholesterol, liver damage, kidney stones, diabetes and osteoporosis. Many patients have stopped taking their drug combinations, due to the side effects, "complicated" dosing schedule and the possibility of drug failure. Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases said that the drug combinations have an 85% success rate in patients who are new to the treatment and who adhere to the complex therapy, although that rate decreases over time. However, the efficacy of the regimens is not as good if the patient has a weakened immune system or has a "built-up resistance [to the drugs] after years of inadequate therapy." Dr. William Powderly of Washington University in St. Louis said, "Three or four years ago, we thought we had turned the corner -- that was wrong. We are starting to see major AIDS infections in our hospital, and we don't have much in the way of [treatment] options." He added, "We can stop the virus from being produced in at least half the people being treated. In half, it isn't successful, and those people will develop resistant virus."

Dropping Drugs Not the Answer in Africa
Although the April agreement of 39 drug firms to drop a lawsuit against a South African law that would allow the country to import or manufacture cheaper AIDS drugs opens the door to AIDS drug access in sub-Saharan Africa, the Times reports that AIDS researchers say that providing the drugs "creates its own set of problems," as Africa has "little or no health infrastructure." Dr. Ronald Gray, an epidemiologist at Johns Hopkins School of Public Health, said, "There is no infrastructure [in Africa] to deliver the care, and the nature of this complicated drug regime means that we will see treatment failure and drug resistance. Drug resistance could wipe out the utility of these drugs in just a few years." Fauci said, "Just parachuting antiretrovirals into a country is not going to stop the [AIDS epidemic], adding, "If we don't make the right choices and deal with this in a comprehensive manner, I think you will see nations disintegrate."

Support for Assistance
President Bush's announcement on Friday that the United States would contribute $200 million to a United Nations global trust fund to fight HIV/AIDS, tuberculosis and malaria has raised questions about the country's commitment to the fight against the disease, the Times reports. According to the Times, "it may be naive to think that Americans will support a massive infusion of aid to deal with AIDS worldwide." A recent survey conducted by World Vision, a Christian charity, showed that 61% of Americans "are not inclined" to help fight AIDS overseas and 54% "are not even inclined to help AIDS orphans." World Vision President Richard Stearns said, "The overall poll results are alarming, especially considering the AIDS epidemic is literally ripping the fabric of society in many African nations" (Carter, Washington Times, 5/13). To read the full report, click here.