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More people in the developing world ore taking anti-HIV drugs;
Kenyan study indicates circumcision prevents transmission
-
oping world who are receiving
anti-HIV drugs jumped 60 percent
tn
in tne
the last six montns
months or
of 2004, to
700,000. That is more than the
number of people on combination therapy in
the United States.
The World Health Organization announced
the “3 X 5” campaign in December 2003, with
the goal of having 3 million people in the devel
oping world on anti-HIV therapy by the end of
2005. Even its most fervent supporters acknowl
edged it was an ambitious goal that would be
difficult to meet.
These latest updated treatment figures, con
tained in a WHO report released Jan. 26, show
both the progress being made and the distance
left to travel. Only one in eight people in the
developing world who would benefit from ther
apy are receiving it.
. “A bigger commitment from South Africa,
Nigeria and India is crucial if the developing
world is to meet this year’s treatment goals,” said
Jim Yong Kim, the head of WHO’s HIV/AIE3S
programs.
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equivalency to the branded products that they
copy. They have not yet been approved by the
FDA and do not qualify for purchase under the
president’s emergency plan.
The Bush administration will propose
spending $3.2 billion for the emergency plan in
the fiscal year 2006 budget, unnamed adminis
tration and congressional sources told Reuters.
Administration critics contend that the
United States should be spending roughly dou
ble the amount it spends—last year it proposed
$2.8 billion in international spending, and
Congress upped that to $2.9 billion inter
nationally—but they acknowledge little sympa
thy in Congress for such massive increases while
other programs are receiving little or no
increase.
Tire HIV viral load of people nearly doubles
when they become infected with malaria. This
is likely because of the additional challenges of
a dual infection to the immune system. Other
research has shown that the likelihixxJ of trans
mitting HIV to an uninfected person increases
proportionally with his or her viral load. Co
infections with other diseases such as malaria,
tuberculosis and sexually transmitted diseases—
often untreated or undertreated because of lim
ited access to health care—helps explain the
higher incidence of infection and faster progres
sion of HIV disease that is seen in much of the
developing world.
C ircumcision
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nother factor affecting the rates of trans
mission is circumcision, or the lack of it.
A study published in rhe Feb. 15 edition of The
Journal of Infectious Disease found that among
presumably heterosexual Kenyan men having
multiple sexual partners, the uncircumcised had
more than twice the risk of acquiring HIV than
did those who were circumcised.
The study was conducted between 1993 and
1997 among 745 male truck drivers in Kenya.
All were initially HIV-negative. Periodically
throughout the trial, they were asked about sex
ual encounters with wives, casual partners and
prostitutes and were screened and treated for
sexually transmitted infections as well as HIV.
Statistical analysis showed that the un
circumcised men became infected once every
80 times they had sex, while rhe circumcised
men became infected once every 200 times.
Earlier studies had pointed to similar find
ings, hut there was a question as to whether cul
tural practices, such as those associated with
being Muslim, were a factor in helping explain
the different rates of infection. Subgroup analy
sis of this study found that was not the case.
Even when controlling for such factors, rhe
probabilities of becoming infected with HIV
remained the same.
The likely explanation is that rhe head of an
uncircumcised penis remains a softer mucus
membrane that HIV can more easily enter,
while the head of a more exposed circumcised
penis develops a tougher layer of skin that is
more resistant to viral entry.
Three large-scale trials are under way in
Africa to determine if voluntary adult circumci
sion offers similar protection. The outcome of
those trials should he known in one to three
years. JRl
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Jim Yong Kim, head of the World Health
Organization’s HIV/AIDS program
One thing that can help speed that prixiess
along is greater use of less expensive generic
drugs. The F<xxl and Drug Administration
approved rhe first generic HIV combination
therapy Jan. 25. However, it is licensed only for
use in rhe developing world.
Aspen Pharmacare of Struth Africa will
manufacture both an AZT/3TC combination
pill and a nevirapine pill at adult-strength for
mulations under licensing agreements with the
pharmaceutical companies that developed the
drugs. The licenses only allow for sales in the
developing world and not in the United States
or Europe.
FDA approval makes the drugs eligible for
purchase under the President’s Emergency Plan
for AIDS Relief, the Bush administration’s
international AIDS initiative. The generic
drugs will cost a third to a half the price of
branded drugs.
Other generic anti-HIV drugs are manufac
tured in India and have been used in some
countries in Africa. However, there has been
some question as to the documentation of their
B ob ROEHR is a free-lance reporter based in
Washington, D.C.