I've been reading and learning a lot about HIV/AIDS, and I thought I would share a couple articles of interest on the topic
- One interesting topic that has gotten a lot more attention recently is the idea of treatment as prevention. When patients are on proper Anti-Retroviral Therapy, their viral loads become very low to the point that they are extremely unlikely to pass on the disease. Without treatment, transmission rates vary based on the type of exposure, ranging from around 0.5% for heterosexual sex for males to 90% for recipients of a blood transfusion from HIV-infected donors. There are ways of lowering all the risks levels (prevention of mother-to-child transmission methods, circumcision, condoms, etc), but for each type, one of the best ways is simply getting people healthier. This article from the Economist gives a good summary of the recent research conclusively showing this and also a good summary of the state of HIV/AIDS transmission and treatment in the world now.
- Another topic that is becoming more important is drug resistance among patients on antiretrovirals. If patients are not adherent to their drug regimens (because of stockouts of drugs, inability to get to the pharmacy, lack of knowledge about adherence, etc), they can develop resistance to the medicines and they have to be switched to (much more expensive) second-line regimens. A scary trend is when patients who have never received treatment for HIV/AIDS have drug-resistant strains because it means that these harder-to-treat strains are spreading in communities from people who have been treated before to people who have not. This article shows that Uganda has a very high percentage of treatment-naive (have never received treatment) patients with resistant strains - much higher than other countries. This may be because treatment was started earlier in Uganda or because treatment rollouts were started, then stopped or simply done poorly. As we're working to get more people access to drugs, it's frightening to think about the potential effects of doing the job poorly - it could mean that people get a disease for which there is no treatment.
Ann Marie, Thank you for composing such challenging and informative reading for us.
ReplyDeleteIs the risk of building up immunity to a good drug part of what kept Paul Farmer walking the drugs out to patients in Haiti, or was he simply trying to keep them on schedule for the full regimen for their own recovery?
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