E-drug: Combination therapy in Africa (2)
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May I add some additional items to Dr. Paul Wangai's list of drawbacks to
HAART:
8. It requires very disciplined compliance for ever.
9. In addition to requirement for monitoring liver and renal
functions (item 4), it also requires immediate and frequent access to
viral load testing. In future it will probably also require similar
access to resistance monitoring and blood drug level monitoring
tests.
10. It diverts scarce resources from more important opportunities to
address basic healthcare--and survival--problems.
11. It requires doctors who are knowledgeable and experienced in its
use.
It seems to me that the evidence is becoming overwhelming that
similar attention paid to other STDs would have much greater impact
on the prevention of the spread of HIV.
In addition, anticipating that short-course AZT therapy will be
proved to be beneficial, we must move very rapidly to implement this
therapy for all who need and want it. So far we have heard that even
the cost of this is way beyond the means of most mothers and most
health services. But it is not an impossibly huge amount to raise and
we _must_ make a determined effort to provide this therapy. It seems
to me that this would be a much more equitable use of funds available
from UNAIDS or other sources. Discussion on this has been very muted.
Are we to wait until the proof is published in NEJM before we start
to take action?
Chris
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Chris W. Green (chrisg@rad.net.id)
Jakarta, Indonesia
Tel: +62-21 846-3029 Fax: +62-21 846-1247
[As E-DRUG readers will know from previous messages, I have strong beliefs
about this topic. In summary, I believe that for low prevelence countries
the cost of screening pregnant women prior to AZT treatment is too high.
For high prevalence countries the cost of the prophylactic AZT treatment
will be excessive. For AIDS patients the costs and benefits are not in
balance when diseases such as TB and STD's are not being treated
adequately. I think that Paul's original comment that we should be looking
more broadly at this topic are very useful. I believe that in African
countries at least major social, behavioral and political changes will be
needed to reduce the epidemic. Uganda has shown the way. For the past five
years the number of new cases and the HIV prevelence has fallen. So it can
be done!
Richard Laing Co-Moderator]
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