E-drug: Antiretrovirals in developing countries (cont'd)
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The MSF-Bangkok commentary had this to say about differences in
respect to patient compliance issues in TB and AIDS treatment:
"Compliance is an important issue with TB treatment (therefore
DOTS). Untreated TB kills and is infective. Compliance is an issue for
ARV too but an important difference is that life prolonging ARV
treatment is something every individual should decide for him/herself."
I don't agree that this distinctionis valid, for the following reasons.
The original report that triggered close attention to patient compliance
in anti-retroviral treatment showed observational data indicating that
multiday lapses ('drug holidays') in protease inhibitor treatment
resulted in emergence of drug-resistant HIV (1).
Taking that result at face value means that a patient who continues to
engage in behavior that makes him/her an ongoing source of trans-
mission of HIV to others has the capability, though erratic compliance
with anti-retroviral treatment, of converting drug sensitive virus to
drug resistant virus, and then of communicating that to others. Is that
any different from a partially compliant TB patient who, because of
intermittent exposure to antimicrobial treatment, develops multi-drug
resistant tubercle bacilli, and then communicates them to others?
Perhaps I'm missing something, but I don't see any basic difference,
except the names of the infective agents involved.
John Urquhart, MD, FRCP(Edin)
Professor of Pharmaco-epidemiology
Maastricht University, Maastricht, NL
Chief Scientist, AARDEX Ltd
APREX Corp, Zug CH & Union City, CA, USA
Professor of Biopharmaceutical Sciences, UCSF, San Francisco
home office: 975 Hamilton Ave, Palo Alto, CA 94301 USA
tel: +1-650-321-3961; fax: +1-650-324-9739
email: urquhart@ix.netcom.com
Reference:
1. Vanhove GF, Schapiro JM, Winters MA, Merigan TC, Blaschke TF.
Patient compliance and drug failure in protease inhibitor monotherapy.
JAMA 276: 1955-6, 1996.
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