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
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.