Health-e (Cape Town)

26 November 2012

Africa: HIV - More Important to Get Patients On Sustainable, Affordable Drugs

Cape Town — After 30 years of HIV disease it is more important to deal with the costs of the medicines and how to sustain access to it, rather than treatment outcomes, according to an HIV specialist.

Addressing the first Southern African HIV Clinicians Society conference today, Professor Brian Guzzard, an expert advisor to the UK government on HIV and head of one of Europe’s largest clinical units, started his talk recalling his visit to South Africa shortly after the release of Nelson Mandela. “The then government told me that HIV will never be a problem in South Africa,” Guzzard told the packed auditorium.

Guzzard said that for the past 10 years they have been trying to get people onto treatment earlier, but that there were no proper randomized trials showing that it should be a priority.

He revealed one study, which was currently taking place, and investigating placing people with HIV on antiretroviral treatment at a CD4 count (measure of the body’s immunity) above 500, was not expected to show any dramatic improvement in outcomes.

He added that studies from the United States showed that patients likely to get onto treatment earlier, as those who are wealthy and often less likely to have a high incidence of HIV infection.

“Thinking of cost and using the appropriate drug is more important that discussing when antiretroviral therapy should be initiated,” said Guzzard.

“We are going to be saddled with treatment for the next 40 years, so let us make it work and accessible. Doctors here need to discuss how to give to the cheapest and simplest treatment to the largest number of patients,” he said.

Speaking in the plenary after Guzzard, Professor Tom Harrison of St Georges University of London focused on cryptococcal meningitis “an every day experience for those working in state hospitals”.

He revealed that 15 percent of all HIV-related deaths were due to cryptococcal meningitis and that current treatment options were inferior. The gold standard treatment is not available or feasible for Africa, according to Harrison.

He added that antiretroviral therapy had not led to any decrease in the incidence of cryptococcal meningitis, but had improved the long-term prognosis for those patients on ARVs.

Harrison said there were enough tools – diagnostics and drugs – available to optimize the management of symptomatic cases.

Cryptococcal meningitis is a fungal infection of the tissues covering the brain and spinal cord (meninges). It is caused by the fungus Cryptococcus neoformans found in soil around the world.

Cryptococcal meningitis most often affects people with a weakened immune system.

The conference continues until Wednesday.

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