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IAC: Long-Range Thinking Urged for HIV Treatment in Third World


TORONTO -- HIV therapy introduced in Third World countries should focus on antiretroviral regimens designed for long-term success, investigators emphasized here.

TORONTO, Aug. 21 -- Regimens that will work for a life-time should be the goal when rolling out antiretroviral programs for Third World settings, AIDS investigators said here.

"This is not a sprint," said Mark Nelson, M.D., director of HIV services at Chelsea and Westminster Hospital in London, "This is a marathon."

Dr. Nelson's opening lecture in the symposium, "Overcoming Challenges in HIV Care: Every Step Matters," presented by Abbott Virology in conjunction with the 16th International AIDS Conference here, was interrupted for 20 minutes by a demonstration by AIDS activists in protest against Abbott's pricing policies. They were particularly perturbed by the raise in the price of Norvir (ritonavir), used to boost blood levels of almost all other protease inhibitors.

Shouting chants such as "Cheap Kaletra Now," the group of about 50 demonstrators took over the stage at the symposium and addressed the audience before leaving. Kaletra, the leading protease inhibitor, consists of lopinavir and Norvir, both marketed by Abbott.

Symposium co-chairman, Joep Lange, M.D., a professor of medicine at the Academic Medical Center in Amsterdam in the Netherlands, said that while he sympathized with some of the points of the demonstrators, he said that Abbott's pricing of Kaletra was the lowest of any protease inhibitor in use in developing countries.

When Dr. Nelson returned to the podium, he explained that when doctors plan to treat HIV infection in Africa, Europe, or the United States they need to keep in mind that therapy will go on for more than one year. He suggested that programs that begin with non-nucleoside reverse transcriptase inhibitors as the base drug may be susceptible to resistance; whereas protease inhibitor-based treatments are less likely to fail because of emergence of HIV resistance.

"A potent HIV regimen is one that offers efficacy, low toxicity and the likelihood of adherence," Dr. Nelson said. "Choose a regimen to avoid treatment failure and suppress viral replication for as long as possible."

He noted that in the long-running Study 720, 59% of patients in the intention to treat original cohort of 100 patients remain on the combination therapy with their HIV levels suppressed to undetectable levels -- seven years after beginning therapy. That means 95% of patients who remain on treatment have virus suppressed to undetectable levels.

Dr. Lange, in his lecture at the symposium, cited the same study, noting that CD4-positive cells in the patients still on treatment had risen an average of 500 cells -- giving these individuals an almost normal CD4-cell count.

"The current momentum for the antiretroviral scale-up provides a unique opportunity to build sustainable healthcare systems in Africa," he said. "AIDS is different because it is a life-long disease requiring life-long treatment. We are now reaching the point where an emergency response will not do."

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