U.S. and Haitian doctors have tripled the survival time of a group of AIDS patients in Haiti by administering standard HIV medicines. The finding shows that, despite the doubts of many people, AIDS drugs work as well in countries with weak health systems and heavy disease burdens as they do in the rich nations.
The Caribbean nation of Haiti is the poorest in the Western Hemisphere. Malnutrition and disease rates there rival sub-Saharan Africa, aggravated by nearly two decades of constant political unrest. In these circumstances, Haitian AIDS patients lacking anti-retroviral medicines typically do not live long.
But a study in the New England Journal of Medicine shows that, with access to these drugs, AIDS patients in the capital, Port-au-Prince, dramatically boosted their survival times.
"Even in a very difficult environment like Haiti, their treatment outcomes were great, just as good as treatment outcomes that one would expect in the United States," said Daniel Fitzgerald, one of the physicians who ran the study.
He says that of the 1,000 infected Haitians who received standard combinations of anti-retroviral medicines, nearly 90 percent of the adults and 98 percent of the children survived one year. That is three times the 30 percent one-year survival rate for untreated Haitians.
Dr. Fitzgerald says the results are all the more impressive because the people who were treated were far sicker to begin with than most American patients.
"There has been some concern, some skepticism, that with the high rates of tuberculosis, with high rates of malaria, with malnutrition, with the limited clinical and laboratory infrastructure in developing countries, we would not be able to get the great results that you see in the United States," he explained. "But the fact is we did."
Because the Haitian patients had been so underfed, the researchers supplemented the AIDS medicines with daily multi-vitamins for all and a monthly stock of rice, beans, and vegetable oil to the most malnourished. The annual cost of care per patient was $1,600, with the drugs accounting for one-third to nearly half the total.
World Health Organization (WHO) AIDS experts call the Haitian study results truly remarkable.
The researchers say their work provides evidence to support international efforts to make anti-retroviral therapy available to AIDS patients worldwide.
The WHO goal has been to get three million AIDS patients on drug therapy by the end of this year. But it has fallen short of the goal by one million people and agency officials note that the number needing treatment far exceeds the capacity to provide it.
However the director of the organization's HIV department, Jim Yong Kim, says much progress has made toward the goal. He cites the creation of the Global Fund to channel increasing amounts of donor money and President Bush's commitment of $15 billion for AIDS drugs and prevention programs in 15 of the most afflicted countries over five years. In addition, the leaders of the eight biggest industrial nations, the so-called G-8, endorsed universal access to anti-retroviral medicines by 2010 at their July meeting in Scotland.
"I think the notion that poor people in Africa, just because they are poor, or poor people in India, just because they are poor, are not going to get access to treatment - I think that in 20 years will be remembered as part of our primitive past," he said. "Is not it wonderful how far we have come that we cannot even consider that sort of thing anymore?"
But a group of 600 AIDS treatment activists from more than 100 countries says many barriers remain to expanding drug therapy around the world. The group, calling itself the International Treatment Preparedness Coalition, argues in a new report that funding is still too low.
Coalition member Chris Collins of the United States also points to inadequate leadership in several countries, bureaucratic delays within the global system, a severe shortage of health care workers, and pervasive stigma against AIDS.
"There are many examples of national governments and international organizations making important strides in treatment delivery over the last couple years," said Mr. Collins. "But the report also demonstrates that without changes on the national and multi-lateral levels, the new G-8 goal will be nothing but a hollow promise."
The World Health Organization's Jim Yong Kim says keeping AIDS patients on affordable drug treatments will be the greatest challenge by far in the years ahead.
