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Frerichs, R.R. Access to HIV treatment ... and testing

SEA-AIDS Network, February 18, 1998

R.R. Frerichs Posting

The efforts of Dr. Joe Thomas and others to bring treatment access to center stage at the coming Geneva AIDS conference are to be lauded. Such voices of concern, when issued often and loud enough, will continue to sensitize people to the importance of producing lower cost treatment regiments for developing countries.

In this regard, the following item from today's CDC Daily AIDS Summary offers hope that new, lower-cost therapies will become available.

"An Inexpensive AIDS Drug?" Washington Post 

(02/06/98) P. A2

At the Fifth Conference on Retroviruses and Opportunistic Infections, Jeffrey E. Galpin of the Sherman Oaks Hospital Research Institute in Los Angeles reported that a combination of an older leukemia treatment drug, hydroxyurea, with the drugs ddI and d4T, reduced the level of HIV in the blood of 42 patients below detectable levels. The new drug is inexpensive--it costs $30 a month -- compared to the $1,300 monthly price tag of combination therapies that use protease inhibitors and reverse transcriptase inhibitors.

Researchers also reported that three HIV-positive patients who received hydroxyurea treatment over a year ago may have permanent remission of the virus. The drug targets host cells in the patient, rather than the virus itself, preventing HIV from developing a resistance to the drug.

The drug also appears to reduce the chances of HIV resistance to other AIDS treatments. While some researchers are skeptical about the remission claims, many have begun incorporating hydroxyurea into existing combination treatments.

What is not stated, but is clearly implied, is that treatment must be preceded by detection. Thus even if lower cost drugs become available, reluctance to test and find HIV infected persons will undermine even the best of intentions. Here in the United States we estimate that 40 percent of HIV infected persons do not know they are infected. UNAIDS assumes for the world as a whole that only 10 percent of those who carry the virus are aware of their infection -- a figure that is likely far too high in most developing countries.

Changes in attitudes toward testing come slowly, but such changes must be brought about if societies are to take full advantage of both treatment and prevention strategies.

The optimistic discussion at the recent Fifth Conference on Retroviruses and Opportunistic Infections about low-cost treatments reminds us that low-cost detection schemes must also be developed.