Two main types of argument are often voiced which hold back development and adoption of antiretroviral therapies in developing countries:
• uncertainty surrounding their biomedical efficacy, given the diversity of the HIV strains existing in Africa, the strong spread of the disease and possible viral resistance to drugs ;
• the difficult social and economic situations: the high cost of medicines and inadequate health systems in most of the countries concerned. Public and government campaigns are for that reason often based solely on preventive measures (supposedly more cost-effective), the possibility of using antiretroviral therapies disregarded, which in any case raises serious ethical problems.
The Barcelona Conference on Aids is being held from 7 to 12 July. Many IRD researchers and their Senegalese partners are giving papers (see abstracts further on). The French National Agency for Aids Research (Agence nationale de recherches sur le sida, ANRS) are running a press information point about access to antiretroviral therapy.
A Franco-Senegalese research team have published in the June 2002 issue of the journal AIDS the result obtained so far, 18 months into a pilot scheme being conducted in Senegal. The experiment is the first to lift doubts surrounding the effectiveness and tolerance of antiretroviral therapies in Africa. It uses now-standard tritherapy regimes. Dr Ibrahima Ndoye of the Senegal National Committee for Aids Control (Comité national de lutte contre le sida du Sénégal ) and Prof Eric Delaporte of the French lnstitut de recherche pour le développement (IRD, Montpellier) are coordinating this trial programme. Results show clearly that there is no clinical or virological justification for putting off the application of antiretroviral therapy programmes to Africa.(see scientific bulletin n°157). The 30-month results have now been analysed and are to be presented during this Barcelona conference.
The IRD has been conducting related epidemiological, socio-anthropological and psychological studies in Senegal. They show that patients' respect of prescriptions was higher than usually found in the industrialized countries. They also indicated strong adherence to courses of treatment. The importance of providing therapy free was highlighted as a means of encouraging people to continue.
This research has helped define the practical arrangements necessary in African health and hygiene situations for setting up a public health programme to take charge of Aids control using antiretroviral drugs. They also reveal that there is little circulation of these medicines in the informal markets. In Senegal strict control of supplies and delivery has avoided misappropriation. Similarly, follow-up care and close support of patients has prevented any resale of the medicines supplied.
Another study, this time in Cameroon, is currently being launched by IRD. Part of the Cameroon project PRESICA (Prévention Sida Cameroun), work is conducted jointly with the country's researchers and with the Swiss Médecins sans Frontières, aiming to assess the effectiveness of treatments using generic antiretroviral drugs costing no more than 30 € per month. Such generic medicines, more suitable for situations in developing countries, will be tested for the first time (patients take one tablet in the morning and in the evening, which contain three antiretroviral agents).
There is concern about the risk that rapid spread of AVR in Africa might prompt the large-scale appearance of resistant strains of HIV. A unit has been set up to monitor instances of resistance, with the support of the French National Agency for Aids Research ANRS, by the IRD jointly with several African laboratories including that of Professor Mboup in Dakar.
The IRD is also deeply involved in training and putting together networks of medical personnel able to supervise follow-up of treatment and support patients by way of these projects which help strongly to build an organized system (development of clinical monitoring procedures, and tools for facilitating compliance with courses of treatment).
These highly promising results open up prospects for longer-term therapeutic strategies which would be accessible to a greater number of patients throughout the African continent.
The Institut de recherche pour le développement (IRD) has been engaged in research on Aids in Africa for around 15 years. Topics focused on include: genetic diversity of HIV strains and its consequences, epidemiology, prevention, medical and social care concerning Aids, demography and social aspects. IRD has several multidisciplinary teams. It is particularly well equipped to conduct studies on assessment of Aids control programmes being run by African countries and on access to anti-HIV treatments in Africa. IRD is present in the field in Senegal, Cameroon, Ivory Coast, Burkina Faso and Thailand, working in close partnership with scientists and health care professionals in these countries. It contributes to many ANRS programmes.
Press Contact: Hélène Deval or Bénédicte Robert
Tel : +33 1.48.03.75.19 ; Email : deval@paris.ird.fr