HAART has substantially improved the prognosis of HIV-infected patients who have access to these drugs. HAART is being scaled up in developing countries but several factors could limit the effectiveness of the therapy in resource-poor settings.
In this study the researchers compared the ART-LINC Collaboration--a network of 18 HAART programmes in Africa, Asia, and South America--with a similar network of 12 HAART programmes in Europe and North America. They found that mortality was higher in low-income settings than in high-income settings. Patients in low-income countries had lower CD4 cell counts (indicating an increased risk of infection) and more advanced clinical disease when they started treatment. However, the authors state that this only partly explains the higher mortality. They believe accompanying illnesses (comorbidities) such as tuberculosis that are present in many low-income settings may have increased mortality. They also found that the provision of treatment free of charge in low-income settings was strongly associated with lower mortality.
Author Dr Matthias Egger (University of Berne, Switzerland) concludes: "Antiretroviral therapy is feasible and effective in low income settings, but, compared with industrialized countries, mortality is high in the first months. Eligibility for antiretroviral treatment and the need for treatment of tuberculosis should be determined earlier, and HAART should be started before serious comorbidities develop."
In an accompanying Editorial, The Lancet comments: "The start of this year has seen new initiatives to raise money to fund HIV prevention and care services, including antiretrovirals and the infrastructure to deliver them, in the developing world. At the World Economic Forum in Davos in January, the pop-music celebrity Bono announced the "Product Red" brand to fight HIV/AIDS in Africa…New philanthropic and taxation efforts to fight HIV/AIDS must be encouraged. The cynical view that businesses are simply getting free good publicity and an increased feel-good factor, and will pass higher charges onto consumers, must be challenged. We support these new initiatives and encourage other businesses to join Product Red."
See also Comment by Nathan Ford (Medecins Sans Frontieres) about registration problems for antiretrovirals in Africa.
This week's World Report looks at AIDS in China and India.
Contact: Dr Matthias Egger, Department of Social and Preventive Medicine (ISPM), University of Berne, CH-3012 Berne, Switzerland. T) +41 31 631 35 01 egger@ispm.unibe.ch
The Lancet press office T) 0207 424 4949/4249 pressoffice@lancet.com
Journal
The Lancet