Lancet Infectious Diseases Publishes Articles on Antiretroviral Treatment Rollout, History of AIDS Treatment
The journal Lancet Infectious Diseases in its August issue published a number of studies and articles on HIV/AIDS. Summaries appear below.
- "AIDS Treatment Enters Its 25th Year," Lancet Infectious Diseases: Research into AIDS treatment was "stymied by both scientific misinformation and the sociopolitical climate" after it was first identified in medical literature in 1981, Roxanne Nelson writes in the article. Although "breakthroughs," such as the development of an HIV test in 1985, the approval of protease inhibitors in 1995 and the introduction of highly active antiretroviral therapy, have "helped transform AIDS into a manageable and chronic disease" for many HIV-positive people, a large number of them continue to lack access to treatment, Nelson writes. In addition, a vaccine and a cure "remain beyond reach," according to the article (Nelson, Lancet Infectious Diseases, August 2006).
- "Containing HIV/AIDS in India: The Unfinished Agenda," Lancet Infectious Diseases: Padma Chandrasekaran of Avahan -- the Bill & Melinda Gates Foundation's five-year, $200 million program to fight HIV/AIDS in India -- and colleagues determined the challenges, status and needs of a national response the HIV/AIDS epidemic in India by examining data from prenatal and sexually transmitted infection clinics; facility-based studies; mapping and size estimation exercises of high-risk groups, such as men who have sex with men, commercial sex workers and injection drug users; and behavior surveys conducted in the general population and high-risk groups in India. The researchers found that "[g]iven India's scale and the diversity and mobility of the populations at risk," national HIV/AIDS efforts must build technical and managerial systems, increase prevention campaigns among high-risk populations, enhance access to treatment and care for higher-risk populations and maintain commitment in building strategic knowledge and evidence-based HIV programs (Chandrasekaran et al., Lancet Infectious Diseases, August 2006).
- "Keeping the G8 Spotlight on Africa," Lancet Infectious Diseases: One year after the Group of Eight industrialized nations at their annual meeting in Gleneagles, Scotland, addressed the problems plaguing Africa, including HIV/AIDS, "what has the G8 achieved" and will the 2006 "Russian presidency [of the G8] continue the momentum?" a Lancet editorial asks. Various progress reports of last year's pledges show that debt relief for Africa is "on track" but that support for the Global Fund To Fight AIDS, Tuberculosis and Malaria "seems to have waned quite substantially over the years," the editorial says. According to the editorial, the G8 should consider supporting a 10-year commitment to health because "[o]nly this way is there any hope of achieving" the U.N. Millennium Development Goals for health. The editorial calls on the G8 to incorporate mechanisms "into its on-going processes, so that when the Russian summit is over, the pressure to do something about the diseases of the world's poor does not disappear until the next summit" (Lancet Infectious Diseases, August 2006).
- "Moving Up From 3 by 5," Lancet Infectious Diseases: If antiretroviral drug programs are rolled out to "under privileged" and rural regions "in a sustainable way, many more people than patients actually under antiretroviral therapy will profit from the programs," Marcel Stoeckle of the St. Francis Designated District Hospital -- an HIV/AIDS treatment center in Ifakara, Tanzania -- and colleagues report in the article. The researchers -- based on their first two years' experience at the clinic in rural Tanzania -- recommend that: national programs "provide a backbone" to aid in patient referrals and integration of health systems; that antiretroviral supply remain sustainable; that staff including "indispensable" adherence assistants at the clinics be adequately trained; and that migration of staff is monitored. They also highlight the need for HIV/AIDS clinics to be integrated with care for other chronic diseases, such as diabetes, to strengthen health systems and reduce stigma (Stoeckle, Lancet Infectious Diseases, August 2006).
- "South African Methamphetamine Boom Could Fuel Further HIV," Lancet Infectious Diseases: An "alarming rise" in crystal meth use in South Africa, especially in the Western Cape province, could further the spread of HIV in the country, Kelly Morris and Charles Parry write in a Lancet Infectious Diseases article. About 45% of people who are being treated for illicit drug use in Cape Town, South Africa, in the second half of 2005 were crystal meth users, and more than 10% of people living in some Cape communities have used the drug, according to recently released data from the South African Community Epidemiology Network on Drug Use, which is run by the South African Medical Research Council. The drug has been linked with "risky sexual behavior and HIV infection" in U.S.-based studies, and the Western Cape has the highest recorded increase of HIV prevalence of any region in South Africa, the authors report (Morris/Parry, Lancet Infectious Diseases, August 2006).
- "Towards Universal Access to HIV Prevention, Treatment, Care, and Support: The Role of Tuberculosis/HIV Collaboration," Lancet Infectious Diseases: Alasdair Reid of the World Health Organization and colleagues analyzed the interactions between TB and HIV in resource-limited settings to determine the need for increased collaborative efforts between HIV and TB programs to provide better diagnostic, treatment and prevention services. According to the researchers, the risk of latent TB increasing to active TB is 20 times greater in people who are HIV-positive than HIV-negative people. However, the presence of HIV does not increase the infectiousness of TB, the researchers found. "Globally we are missing millions of opportunities each year to provide HIV prevention, treatment and care within TB services and vice versa," the researchers write, concluding that to reach the MGDs for health, "collaboration between TB and HIV communities to maximize access to existing, effective interventions must be our collective global responsibility" (Reid et al., Lancet Infectious Diseases, August 2006).