Thursday, June 2, 2011

After 30 Years with AIDS, Solid Signs of Progress

By Jeff Baron
IIP Digital Staff Writer
Washington — The director of the U.S. effort to stop HIV/AIDS around the world offers good news for the disease’s 30th birthday: More people are being treated, their lives are better, fewer are dying and fewer are being infected.

The cost of treating people is even going down.

Ambassador Eric Goosby, the U.S. global HIV/AIDS coordinator and director of the President’s Emergency Plan for AIDS Relief, or PEPFAR, briefed reporters in advance of a United Nations meeting on HIV/AIDS June 8–10 to mark 30 years since the emergence of the disease.

With no vaccine or outright cure available for HIV infection, Goosby said, PEPFAR has achieved remarkable success in cutting the spread of HIV/AIDS and vastly improving and extending the lives of those infected, and it will meet its target of treating more than 4 million people by 2013.

The program has been especially effective at preventing the transmission of HIV from infected women to their babies during or after birth, preventing an estimated 386,000 infant infections in seven years. In each of the nine worst-hit African countries, the number of new infections dropped by 10 percent or more — in the case of Namibia, by 81 percent — from 2001 to 2009. HIV/AIDS-related deaths have dropped by a quarter in sub-Saharan Africa over seven years, from 1.6 million to 1.2 million, as PEPFAR funding has increased.

“We certainly can take some credit for that drop,” Goosby said.

PEPFAR has been treating a larger and larger share of the estimated 33.6 million people worldwide who have HIV/AIDS: up from 1.7 million in 2008 to 3.2 million in treatment in 2010. And its treatment costs have dropped by about two-thirds, from $1,300 per patient per year (including anti-retroviral drugs and the cost of doctors and nurses) to about $450. The big savings, about $380 million in 2010, came from the switch to generic drugs.

Goosby said PEPFAR will try to coordinate planning and purchasing with the Global Fund to Fight AIDS, Tuberculosis and Malaria in hopes of driving costs down further, and his office is doing a country-by-country evaluation to look for more savings, but he said they won’t be as dramatic.

In June 1981, when the U.S. Centers for Disease Control first reported on a mysterious outbreak that later became known as AIDS, Goosby was a chief resident at a hospital in San Francisco, and the disease has been central to his career ever since. He said he had been attracted to treating infectious diseases, “diseases that I could cure,” but he soon was running a clinic that was losing 15 to 30 patients to AIDS each week. “We got very good at diagnosing and treating opportunistic infections early, but that was only for that one infection, two infections, usually three or four infections, and then the fourth or fifth one would take the patient,” he said.

The contrast in the outlook for patients in 1980s San Francisco and those in today’s sub-Saharan Africa is stark. New patients in Africa benefit from 30 years of advances, most notably a combination therapy of three anti-retroviral drugs with proven effectiveness.

PEPFAR has kept supplies available and patients have learned the importance of sticking with their medication. As a result only 2 percent to 3 percent of patients in Africa have had to move to a second line of medication, compared with 15 percent to 30 percent of U.S. patients.

“A person who’s been on anti-retrovirals, they don’t develop a resistant organism because the organism’s not dividing,” Goosby said.

PEPFAR cares for 3.8 million orphans and vulnerable children, and it has the world’s largest program against gender-based violence, Goosby said. And although it is designed to combat AIDS, the systems built with PEPFAR support have helped improve maternal and child health care as well as treat such chronic diseases as high blood pressure and diabetes.

One factor in PEPFAR’s success, Goosby said, is that it has begun turning over the direction of its programs to the countries in which it operates. With the help of some high-level diplomacy, he said, the gradual transition has been effective even in some countries that are less accepting of injection drug users and men who have sex with men — two groups whose treatment is critical to keeping HIV from spreading to the general population.

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