WHO, UNAIDS Meeting Discusses 3 by 5 Initiative, Fixed-Dose Combination Antiretroviral Drugs
The world is "moving much too slowly" to provide antiretroviral drug therapy to HIV-positive people in the developing world, Kathleen Cravero, deputy director of UNAIDS, said on Sunday during a satellite meeting jointly sponsored by the World Health Organization and UNAIDS on the sidelines of the XV International AIDS Conference in Bangkok, Thailand. Cravero, who spoke on behalf of UNAIDS Executive Director Peter Piot, said that WHO's 3 by 5 Initiative -- which aims to treat three million people by 2005 -- is achievable. Jim Kim, WHO director of HIV/AIDS, acknowledged that the organization until recently had not been involved as much as it should have been in the fight against the epidemic, and he added that the agency had put itself "under the gun" by launching the 3 by 5 Initiative. However, Kim said that without treatment, some countries "could be facing social collapse" within a few generations and increased attention to treatment could increase funding for both treatment and prevention programs. Kim concluded that WHO would "kill ourselves" to do everything to make the initiative a success.
Panel on Fixed-Dose Combination Antiretroviral Drugs
Michel Kazatchkine, director of France's Agence Nationale de Recherches sur la Sida, who chaired a panel discussion on fixed-dose combination antiretroviral drugs, said that FDCs make treatment regimens simpler, are user-friendly and are "more attractive" as first-line therapy. In addition, FDCs are affordable and are easy for local and district programs to distribute and manage, Kazatchkine said. Sinata Koulla-Shiro, a physician from Cameroon, reported on a study recently published in the Lancet that found that Triomune, a generic FDC containing nevirapine, stavudine and lamivudine, was "very effective and safe" in treating patients with "profound immunodeficiency." She added that Triomune meets the qualities of first-line therapy, especially to attain the goals of the 3 by 5 initiative. Joia Mukherjee of Partners in Health said that antiretroviral drugs in developing countries must be provided to patients free of charge, because if patients are required to pay anything, they will have to decide whether to pay for their medications or food for their children.
'Momentum is Moving,' Lewis Says
U.N. Special Envoy for HIV/AIDS in Africa Stephen Lewis, who gave the closing address of the meeting, said that the 3 by 5 Initiative is "the most visionary initiative ever to emerge from the U.N. family." Lewis listed six areas on which the world must focus in the fight against AIDS, including improving health care capacity and infrastructure; providing antiretroviral drugs free of charge; revising intellectual property guidelines; expanding prevention programs; abolishing stigma and discrimination; and increasing resources. Lewis also said he was "astonished" by data in the UNAIDS report showing that 75% of all HIV-positive people ages 15 to 24 are women, adding that it is "a hallucinatory number" for that age group. He said that more needed to be done to ensure gender equality in HIV/AIDS treatment and prevention programs. Lewis concluded, "The momentum [to fight AIDS] is moving on the ground and is ready to take off if only the world would coherently respond" (Alyson Browett, Kaiser Daily HIV/AIDS Report, 7/11).
A webcast of the complete session is available online from kaisernetwork.org.