HIV, HCV, TB services not reaching the most-in-need

At the XIX International AIDS Conference (AIDS 2012) the message is clear: it will be the task of the activists, implementers, policy makers, scientists, and each one of us to work together to turn the tide so that everyone who needs high-quality treatment and prevention interventions for the global HIV, hepatitis C virus (HCV), and tuberculosis (TB) pandemics receive them. "The 2012 Pipeline Report: HIV, HCV, and TB Drugs, Diagnostics, Vaccines, and Preventive Technologies in Development" which was released at AIDS 2012 by HIV i-Base and Treatment Action Group (TAG) reveals the deepening gulf between new scientific advances that make it possible to prevent, treat, and in some cases cure people living with HIV, HCV, and TB; and access to these where they are most needed. 

Polly Clayden of i-Base and Mark Harrington of TAG, stated that, “the abundance of promising advances in HIV/AIDS prevention and treatment documented in this year’s ‘Pipeline Report’ may seem unattainably out of reach to many of the millions of people who need them most”.

HIV i-Base is a London-based HIV treatment activist organization and works to ensure that people living with HIV are actively engaged in their own treatment and are included in policy discussions about HIV treatment recommendations and access. The Treatment Action Group (TAG) is an independent AIDS research and policy think tank fighting for better treatment, a vaccine, and a cure for AIDS.

Pointing to the recent dramatic demonstration that earlier anti-HIV therapy can reduce transmission of the virus by 96% among stable sexual partners with differing HIV status, Clayden and Harrington comment, “Three papers published in the past year provide the scientific, public health, and policy framework for accelerating the response to the HIV pandemic such that within a few years the spread of HIV can be reversed, saving millions of lives and billions of dollars, using existing antiretroviral therapy earlier and more broadly around the world. The only thing holding us back is the lack of economic and political leadership at the highest levels.”

The authors point out that while 7 million people are receiving lifesaving HIV treatment, the new scientific results indicate that up to 27 million more will need such therapy to realize the promise of earlier treatment for both individuals and public health. More preliminary results also suggest that targeting HIV prophylaxis for high-risk HIV-negative individuals can alsom prevent transmission, when administered in well-organized and comprehensive prevention programs, as indicated by the U.S. Food and Drug Administration (FDA) approval, earlier this month, of the first two-drug combination licensed for HIV prevention. Still more preliminarily, a single patient, Timothy Brown, has been cured of HIV infection after receiving an immune system transplant with stem cells genetically resistant to HIV. Brown has remained off HIV treatment for more than five years with no ongoing HIV replication detected.

Moving to the HCV pandemic, which affects over 160 million people worldwide and is the leading cause of death among people with HIV in America and Europe, authors of the report, Tracy Swan and Karyn Kaplan provide a sweeping overview of the explosive developments in HCV combination therapy and cure. Swan and Kaplan caution that currently infrastructure and reimbursement mechanisms to cover treatment and care costs for people with HCV are lacking almost everywhere, and must be rapidly expanded to treat and cure the millions who are living with HCV.

TB research has undergone a renaissance, particularly in TB drugs and regimens. Erica Lessem, another author of the report, states that research shows significant progress in new TB drug and regimen development, but as slow progress in TB diagnostics and vaccine research reveals, investment in TB research is far too low to permit rapid progress.

The report calls on political leaders worldwide to step up implementation of these new scientific discoveries to bridge the global and domestic prevention and treatment gaps.

Ishdeep Kohli
(The author serves as the Vice President, Jodhpur National University; and also as the Executive Director of Swasthya India. She has written extensively on HIV and health issues)

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