Test and Treat to End HIV in 40 Years

posted: 22/02/2010

A global public health strategy for testing and treating everyone with HIV is now being considered.
Health officials are considering a radical shift in the strategy against HIV that would see everyone tested for the virus and people with HIV then put on a lifetime course of drugs. The strategy, which would involve testing most of the world's population for HIV, aims to reduce the transmission so much that HIV would die out completely over the next 40 years.
 

Brian Williams, professor of epidemiology at the South African Centre for Epidemiological Modelling and Analysis in Stellenbosch, said that HIV transmission could be stopped within five years with the use of antiretroviral drugs (ARVs). "The epidemic of HIV is really one of the worst plagues of human history," Williams told the American Association for the Advancement of Science meeting in San Diego. "I hope we can get to the starting line in one to two years and get complete coverage of patients in five years. Maybe that's being optimistic, but we're facing Armageddon."
 

Two years of trials now
Major trials of this universal test and treat strategy are planned in Africa and the USA and will affect whether this becomes part of global public health policy in the next two years.
More than 30 million people are infected with HIV globally and two million die of the disease each year. But across the globe only 12% of those living with HIV get the treatment they need. The disease is overwhelmingly prevalent in sub-Saharan Africa, which accounts for a quarter of all HIV cases globally. Half of these are in South Africa.
 

Broadly the epidemic calculations are that a person with HIV may pass on HIV to between five to 10 others in their time with HIV. Treating people within a year of becoming infected can reduce transmission tenfold, enough to cause the HIV epidemic to die out.
 

Trials plans
In the trials, people will be offered HIV tests once a year, either as routine when they visit their GP, or through mobile clinics in more remote regions. Those testing positive will be put on a lifetime course of ARVs.
"Over the past 25 years we have saved the lives of probably two to three million people using antiretroviral drugs, but almost nothing we have done has had any impact on transmission of the disease," Williams said. "We have stopped people dying but we haven't stopped the epidemic."
If patients take ARVs when they should, the amount of virus in their bodies should fall so low that it becomes undetectable, and they are then extremely unlikely to pass the virus on.

Five years to see the results but worth the price
"The question is, can we use these drugs not only to keep people alive, but also to stop transmission and I believe that we can. We could effectively stop transmission of HIV in five years." Scientists estimate that the cost of implementing the strategy in South Africa alone will be $3bn-$4bn a year. The world currently spends $30bn (£19.4bn) a year on HIV research and treatment, a figure that some experts believe will double over the next decade.
 

Sub-Saharan Africa has seen a dramatic rise in cases of tuberculosis among HIV patients, who are also susceptible to other infections because their immune systems are weakened.
"If you factor in all of the costs, in my opinion, doing this would be cost saving from day one, because the cost of the drugs would be more than balanced by the cost of treating people for all of these other diseases and then letting them die," Williams said. "We're killing probably half a million young adults every year in the prime of their life just at the point where they should be contributing to society and the cost of that to society is enormous," he added. "The only thing that's more expensive than doing this is not doing this."
 

HIV patients in southern Africa are more likely to take ARVs when they should than people living in developed countries, according to health officials. The finding gives doctors hope that the blanket administering of drugs might suppress the virus enough that it dies out naturally.

George House Trust comment 

This assumes a great deal. We are still a long way from providing treatment to all the millions of people in sub-Saharan Africa who need it. This strategy would require us to deliver HIV treatment for vastly more people, reliably, day after day, for decades.

The computer prediction of the epidemic will be correct as long as every African does get tested for HIV every year, everyone who tests positive then starts taking antiretrovirals immediately and 98 out of 100 do not miss a dose. How would people in the UK respond if outsiders decided all adults in the UK must have a HIV test every year?

We know gay men in rich countries use condoms far less now than before effective treatment became available in the mid 1990s, but somehow it's assumed heterosexuals in Africa won't also use condoms less.  

Source

 

Global Treatments Working

posted: 24/11/2009

The death toll from HIV across the world fell by more than 10% over the past five years, latest figures show. The World Health Organization and the Joint UN Programme on HIV/AIDS (UNAids) say that since effective treatments first became available in 1996, some 2.9 million lives have been saved.

As the number of deaths has fallen, the number of people living with HIV has risen slightly - an estimated 33.4 million people worldwide are infected with HIV, up from 33 million in 2007 because of fewer deaths.
 

New infections fall
The latest report also shows there has been a significant drop in the number of new HIV infections. The report suggests that HIV prevention programmes are having a significant impact - new HIV infections have fallen by 17% over the past eight years.
 

In sub-Saharan Africa, the epicentre of the global pandemic, the number of new infections has fallen by around 15% since 2001 - equating to about 400,000 fewer infections in 2008 alone. In the same period, infection rates were down by nearly 25% in East Asia, and by 10% in South and South East Asia. In Eastern Europe, after a dramatic increase in new infections among injecting drug users, the rate of infection has levelled off considerably.
 

UNAids executive director Michel Sidibe said although prevention programmes had helped cut new infections, they were often "off the mark". "If we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved," he said.

Prioritise Gay Men in UK

Deborah Jack, chief executive of National AIDS Trust, said: “The downward trend in new infections is a testament to the work of the international HIV community. It’s the result of the roll-out of treatment and increased investment in prevention initiatives.

"However today’s report shows there are gaps in prevention programmes that meet the needs of key groups, such as over 25s and gay men. We need to get smarter about HIV prevention and also sustain efforts to find new tools such as microbicides and a vaccine, if we are to seriously reduce new infections.

"Worryingly, the global decrease in new infections is not being seen in the UK. Here new diagnoses have trebled in the past ten years. HIV diagnoses among men who have sex with men in the UK rose by 74 per cent between 2000 and 2007. The UK needs to re-prioritise HIV prevention among gay men, otherwise we risk falling further behind.”
 

UNAIDS global HIV epidemic update 2009

Source

5M Still Waiting for Treatment

posted: 01/10/2009

Although four million people are now receiving antiretroviral treatment in low and middle-income countries, another five million adults and children lack access to treatment, according to figures released today by United Nations agencies.

The report Towards universal access: scaling up priority HIV/AIDS interventions in the health sector is published by the World Health Organization, UNAIDS and UNICEF, and is the third annual review of international progress towards the goal of universal access to treatment and prevention by 2010.

Although more than a million people are estimated to have been enrolled into treatment programmes during 2008 alone, the biggest annual increase since treatment scale-up began, only 42% of those in need of treatment in low and middle-income countries are currently being reached.

Mothers and babies

The report also reveals major gaps in two priority areas, the prevention of mother to child transmission and treatment of children.

The report estimates that 21% of pregnant women received an HIV test in 2008, and 45% received drugs to prevent mother to child transmission, of whom around one-third received only single-dose nevirapine, the least effective form of preventive treatment. Only one-third of those who tested positive were assessed for eligibility for antiretroviral treatment for their own health.

Although 38% of children with HIV in low- and middle-income countries in need of treatment received it, infant diagnosis continues to lag behind. In 41 reporting low- and middle-income countries only 15% of children born to HIV-infected mothers were tested for HIV within the first two months of life.

Background to universal access
In 2001 the convening of The United Nations Special Session on HIV/AIDS marked an historic beginning. For the first time a global set of targets was agreed in response to the crisis. In 2006 at the second United Nations General Assembly High Level Meeting on HIV/AIDS, countries agreed to work towards the goal of “universal access to comprehensive prevention programmes, treatment, care and support” by 2010. The G8 Final declaration in L’Aquila, Italy in July 2009 claimed “We will implement further efforts towards universal access to HIV/AIDS prevention, treatment, care and support by 2010”

WHO, UNICEF and UNAIDS in collaboration with other international monitoring and reporting mechanisms have been monitoring progress, nationally, regionally and globally, of the health sector’s response to HIV. The report presented today is the third in a series of annual progress reports towards universal access that includes HIV services for women and children.

Reports standardised

WHO together with UNICEF developed a joint reporting tool to request information from national programmes to collect data on the scale-up of health sector interventions in response to HIV. The goal of this process is to facilitate the collection of a standardised set of information.

By the end of 2008 between 3.7 and 4.3 million people were on antiretroviral treatment including an estimated 275,700 children (38% of those in need) under the age of 15 years.

Progress varies by country and region. In sub-Saharan Africa, for example, where two-thirds of all global infections occur, an estimated 2.9 million people were on treatment by the end of 2008, with an approximate increase of 800,000 people during 2008.

edited from aidsmap

Reference
WHO, UNICEF, UNAIDS. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. September 2009.

Global Treatment Timebomb

posted: 14/07/2009

The price of new HIV medicines for the world’s poorest need to be reduced urgently according to a report by MPs published today, following a five month inquiry.
 

The report, The Treatment Timebomb, describes how by 2030 over 50 million people will need HIV treatment compared to just 9 million who need it today.
 

Second line treatments cost at least 7 times more

In addition, millions of those needing treatment in future will need more expensive medicines, having become resistant to the basic HIV combination therapy. These ‘second-line’ treatments currently cost at least seven times more. When the basic treatment stops working, getting them is a matter of life or death. Some people will also need to switch from the basic combination to newer less-toxic drugs because they experience serious side effects.
 

“We are sitting on a treatment timebomb.” said David Borrow MP, Chair of The All Party Parliamentary Group on AIDS that wrote report. “We must reduce the price of second-line medicines and less toxic first-line medicines before millions need them. We cannot sleepwalk into a situation where we can only afford to treat a tiny proportion of those infected.”
 

Failing to reach 2010 target of treatment for all

Governments around the world, including the UK, signed up to the goal of ‘Universal Access to HIV treatment, prevention, care and support’ by 2010. The world is not on track to meet this target with only a third of the nine million people who need it having access to HIV treatment. This is despite the fact that for now, most people are on the cheapest therapy.

Pricing cuts were made and need repeating
Cutting the price of medicines is possible. Ten years ago the basic HIV treatment cost over $10,000 per person, per year. Today, thanks to cheaper own-label generic versions, these same medicines are available for just $87 per person enabling 3 million people to be treated across the world.
 

The report argues that to avoid a treatment crisis these kind of price reductions need to happen again with the newer HIV medicines. It urges pharmaceutical companies to cooperate by allowing generic manufacturers to produce their HIV medicines cheaply for developing countries. It asks them to put their patents into a ‘patent pool’ for this purpose. Over 100 MPs have also signed a motion asking companies to do this, but so far no company has agreed to do so.
 

Patent Pool

The ‘patent pool’ would also allow researchers to work on making HIV medicines suited to the developing world. Currently many HIV medicines are designed for a developed country market and do not consider issues such as what happens when a person needs to take HIV medicines and TB medicines at the same time. There are also not many special HIV drugs for children, because they have not been developed because drug development is driven by the size of profitable markets and there are hardly any children in the developed world with HIV. The patent pool is being set up by UNITAID, which is part of the World Health Organisation. Drug company GSK has created its own ‘patent pool’ but it has put no HIV drugs into it. 

GSK, since the Parliamentary Group's report was released, has announced a 'Positive Action for Children’ Fund, seed funding to research and develop new HIV/AIDS medicines for children, made a commitment to collaborate with other drugs companies to develop fixed-dosed pills, and announced a royalty free licence for abacavir. 

The David Burrow, MP, chair of the All Party Group responded:

"The All Party Parliamentary Group on AIDS welcomes GSK's new commitments especially on preventing mother to child transmission of HIV, and increasing research on paediatric drugs, both of which are themes of our report, The Treatment Timebomb. The announcement about working with other companies to make fixed dose combinations may also be welcome - but we have no detail yet on what those companies will be and for which medicines.

GSK is taking positive steps, but they are broadly uni-lateral, which will limit their impact. We would like to see them work with UNITAID to create a patent pool which gives fair royalties for their patents; a proposal which DFID and all the major UK charities support." 

 

International Development Minister, Mike Foster, said:
“The simple fact is that the HIV epidemic continues to outstrip our best efforts. Five people are infected with HIV every minute and for every two people put on treatment, there are 5 people newly infected with HIV. This important report reminds us that while it is absolutely vital that we work to reduce the human cost of HIV by focusing our efforts on preventing new infections, we must also face up to the stark reality of the treatment challenge we face. The pharmaceutical industry has an opportunity to act now to help prevent future human catastrophe. It is time for them to state their clear commitment to make new HIV medicines affordable to those who need them most, by working with UNITAID to develop a patent pool”
 

Download The Treatment Timebomb Report from George House Trust

Download The Treatment Timebomb Report from aidsportal.org

Minister - Pool HIV Drug Patents

posted: 13/07/2009

Drug companies should give up their patent rights to HIV medicines to help prevent the deaths of millions of people in poor countries, a British government minister will say this week.

The international development minister, Mike Foster, will call on pharmaceutical companies to put lives before profits, as the all-party parliamentary group on AIDS publishes a report this week detailing the scale of the "treatment timebomb". By 2030, they estimate, 50 million people will need new drugs, which are currently prohibitively expensive, to keep them alive.

Three million people are on cheap, basic HIV drug combinations, but they are only a third of those needing treatment, and resistance is growing to these drugs both in the developing world and in the west.

New and improved drugs are urgently required, but they are expensive, and cheap generic copies of the newest drugs can no longer easily be made and sold because of tightened intellectual property rules in India and China.

The UK generally has a very close relationship with the drug companies, which regard patents as the means of recouping the substantial costs of researching and developing new drugs.

Patent pool solution

But Foster says they must change their stance on HIV. He wants companies to contribute to a "patent pool", which the international drug-purchasing facility, Unitaid – set up by a number of donor countries, including the UK – is trying to establish.

"While it is absolutely vital that we work to reduce the human cost of HIV by focusing our efforts on preventing new infections, we must also face up to the stark reality of the treatment challenge we face. The pharmaceutical industry has an opportunity to act now to help prevent future human catastrophe. It is time for them to state their clear commitment to make new HIV medicines affordable to those who need them most."

Pool opens way for generics

According to the all-party report, if HIV patents are put in a pool, generics companies – which make the cheap combinations now used in Africa – will be permitted to make low-cost copies of newer drugs and devise new combinations in a single pill, which is important for people living in poverty.

The report lays out in stark terms the coming crisis. "It took political activism almost a decade ago to make life-saving drugs available to the poor in developing countries," it says. "Only a third of those who need it are on treatment and this treatment will not work for them forever. Political activism is needed once more to ensure that the next generation of drugs is available to the world's poorest in future."

Treatment need timebomb

MP David Barrow, who chairs the group, said: "We are sitting on a treatment timebomb. We must reduce the price of second-line medicines and less toxic first-line medicines before millions need them. We cannot sleepwalk into a situation where we can only afford to treat a tiny proportion of those infected."

The only way to end the HIV/Aids epidemic is to prevent infection, the report says, but because the drugs suppress the virus, those receiving treatment are much less likely to pass it on.
 

Source