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[Unpublished] .  p.Since HIV was first identified as the cause of AIDS, a number of research efforts have been concentrated on identifying and developing antiretroviral compounds to suppress its replication. Over the years, these researches have noted that sustained suppression of HIV replication is achievable through the use of triple antiretroviral therapy. However, reservoirs of HIV in patients under treatment still remain and there are studies which indicate that the virus may not be latent but instead replicating at a slow rate. In this perspective, researchers are seeking alternatives to triple therapy, and looking at quadruple therapy and new classes of drugs. In the meantime, it is generally accepted that combination therapy represents the best treatment option available. Hence, the long-term sustainability and safety of antiretrovirals is emphasized. Given the gross imbalance in availability and access to antiretrovirals between the industrialized and developing countries, a set of guiding principles has been drawn up by the WHO and Joint UN Programme on HIV/AIDS (UNAIDS). Moreover, UNAIDS efforts in improving access to antiretrovirals are being acknowledged, particularly in developing countries.
Death watch, Part 5. An unequal calculus of life and death. As millions perished in pandemic, firms debated access to drugs.
WASHINGTON POST. 2000 Dec 27; A1.In response to the starkness of the global divide between the HIV-positive people and the ones saved from infection, and its growing political repercussions, the pharmaceutical industry and governments have pledged help. Five international agencies (Joint UN Programme on HIV/AIDS, WHO, UN International Children's Emergency Fund, World Bank, and UN Development Program) conducted a meeting with five pharmaceutical companies (Merck, Hoffmann-La Roche, Bristol-Myers Squibb, Glaxo Wellcome, and Boehringer Ingelheim) to negotiate global access to AIDS drugs. Although negotiations began in Geneva in 1991 and lasted for 2 years, both parties have been hesitant to reach a compromise because of one major factor--the price. These companies say they are willing to provide big discounts, yet they required that the concerned government and these international agencies should burden some of the expenses. However, it came out that even these international agencies are reluctant to invest in AIDS drugs saying that it is “cost-ineffective”. The bottomline of the negotiation is that financial resources play an important part when discussing global access to AIDS drugs and until this can be settled, millions of HIV-infected individuals will continue to suffer.
Death watch, Part 6. A turning point that left millions behind. Drug discounts benefit few while protecting pharmaceutical companies' profits.
WASHINGTON POST. 2000 Dec 28; A1.The deal between 5 major pharmaceutical companies and 5 international agencies announced on May 11, 2000 to provide affordable AIDS medicines in poor countries was considered a turning point in the world’s response to the poorest AIDS sufferers. It is noted that doubts and disputes rived the potential partners, and each side tried in some measure to subvert the other’s goals. The agencies had an unspoken aim to drive prices of patented AIDS drugs down to the level of generics, and to make those prices available as widely as possible. Meanwhile, the drug companies are negotiating variable prices in strict confidence and neither the companies nor their partners have committed in practical terms to bring treatment to significant numbers of the dying. The drug discounts proposed and implemented have benefited only a few while protecting pharmaceutical companies’ profits.
Bulletin of the World Health Organization. 2000; 78(12):1454-5.Malaria is unarguably a disease that can still be both prevented and treated effectively. It is also a large and growing burden of disease in the world that is grossly inconsistent with modern health standards, and it receives far too little attention. The Roll Back Malaria (RBM) movement was established as a response to the situation. The RBM goal is to continue developing a reserve of effective technologies for preventing and treating malaria. This article discusses some of the challenges in the task of reducing incidence of malaria. Five main concerns expressed at a WHO round table discussion were: massive cost, resistance to drugs and insecticides, inadequate local capacity, the false impression that there has been a lack of new initiatives, and the horizontal approach. Overall, it is emphasized that such difficulties can be tackled by applying science, human and financial resources, and effective organization. Most important, though, is the recognition of the need to oppose the suffering and deprivation caused by malaria.
SANASO NEWSLETTER. 2000 Jan-Mar; (35):11.Following an AIDS consultation in Harare, experts agreed to recommend the use of cotrimoxazole in sub-Saharan Africa. It is noted that the drug has proved to be effective in warding off some of the infections to which HIV-infected patients are prone. The Joint UN Programme on HIV/AIDS and WHO have welcomed this recommendation for the drug's use among HIV-positive patients in Africa; however, some scientists argue that the use of the drug in sub-Saharan is questionable, because the parasitic type of pneumonia, for whose prevention the drug is routinely used in the West, is not as prevalent in Africa. In addition, concerns have been expressed that most patients in Africa will not have access to, or be able to afford alternative drugs if they develop resistance to cotrimoxazole. Despite these issues, the experts in Harare agreed to recommend the drug as a medium-term solution while awaiting the results of research into other antimicrobial agents.
Lancet. 2000 Jul 22; 356(9226):340.The article of R. Shretta and colleagues stresses that the difficulties involving drug-donation programs in developing countries are not adequately addressed by WHO guidelines. In addition, there has been a failure to appreciate the context within which public-private health partnerships are set up and the implications of an altered landscape of international health cooperation. In an overview of partnerships by Walt and Buse, it has been found that they tend to divert attention from other health priorities, while failing to provide adequate support to health system strengthening upon which public health programs rest. Moreover, partnership institutions were indicated to rarely conform to principles of good governance and rarely provide for a balanced representation in their decision-making and technical bodies. However, it is believed that some of the private resources available for partnership activities should be harnessed as a sustainable source of finance with which to strengthen the WHO.
WHO / UNAIDS hail consensus on cotrimoxazole use for prevention of HIV related infections in Africa.
AIDS WEEKLY. 2000 Apr 17-24; 16-7.This article reports on the recommendation of the WHO/Joint UN Program on AIDS/HIV to promote the use of cotrimoxazole for the prevention of HIV-related infections in Africa. Several arguments have been raised since the recommendation for its use. Controversies lie in its efficacy in treating opportunistic infections despite its use for Pneumocystis carinii pneumonia. Researchers, however, argue that the drug is effective in preventing certain kinds of bacterial pneumonia and diarrheal diseases, as well as certain septicemia. Furthermore, it can also protect the individual against toxoplasmosis and isosporiasis. Another challenge faced in deciding whether to recommend the use of cotrimoxazole is the risk of creating microbial resistance to the drug if it is widely used as a prophylactic. Weighing the use of cotrimoxazole against the two challenges of differing infections and possible resistance in a region like sub-Saharan Africa would still yield to the urgent need of preventing opportunistic infections in people living with AIDS/HIV.