Fourth Article in Lancet Series Examines HIV Treatment, Vaccines in Africa
The fourth article in the Lancet's five-part series on AIDS in Africa examines the need for antiretroviral treatment for Africans with HIV/AIDS and the necessity of an HIV vaccine that is specific to strains of the virus that are prevalent in the region. Dr. Paul Weidle and colleagues from the CDC and the London School of Hygiene and Tropical Medicine emphasize the importance of antiretroviral treatment and an HIV vaccine for Africans and outline action steps that can help work toward these goals. A summary of the recommendations is presented below:
- Initiating antiretroviral treatment: For publicly funded programs, people with symptomatic HIV should be the first to receive antiretroviral treatment, and asymptomatic patients with low CD4+ T cell counts should be the next in line for therapy. When CD4+ T cell levels cannot be determined, treatment should be initiated in patients with early symptomatic disease with low lymphocyte counts.
- Standardized antiretroviral regimens: Standardized antiretroviral therapy regimens have been proposed for developing nations, and these regimens have several benefits, the authors state. Standardized regimens simplify training and education of providers and patients, are consistent with international standards but account for local drug availability, have streamlined monitoring for toxicity and help support drug adherence, the article states.
- Community support: Gaining the support of important community figures, such as religious leaders, local medical providers and traditional healers, can help develop a "supportive environment and dispel misconceptions about treatment."
- HIV vaccine development: Three small-scale HIV vaccine trials in Uganda and Kenya have demonstrated that "such trials could be successfully undertaken" on the continent and have helped identify issues that need to be addressed in planning future vaccine trials in Africa. Developing an HIV vaccine that is widely effective will likely require a series of HIV vaccine trials conducted in parallel and in sequence, the authors state.