HIV treatment access improves, but coverage low
NEW YORK (Reuters Health) - As of the end of 2007, close to 3 million HIV-infected individuals in low- and middle-income nations had access to antiretroviral drug therapy (ART), representing an increase of nearly 950,000 people who received ART last year.
This reflects a 7-fold increase in treatment access over a 4-year period, which was spurred on by the "3 by 5" initiative proposed by the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) in 2003 to have "3 million HIV-infected people on treatment by 2005." Although not achieved in the proposed time frame, it accelerated the global effort to get ART to low- and middle-income countries.
Despite these important gains, nearly 2.5 million new HIV infections occurred during in 2007 and 2.1 million died of AIDS, according to a report released today by the WHO, UNAIDS and the United Nations Children's Fund (UNICEF).
Moreover, treatment need still outpaces availability, with the majority of HIV-infected people in low- and middle-income nations who need treatment -- approximately 69 percent -- still not receiving treatment.
"Treatment doesn't close down the epidemic," Dr. Kevin M. De Cock, Director, HIV/AIDS Department at WHO, cautioned during a teleconference that coincided with the release of the report. "More investment in prevention is needed while scaling up treatment."
Progress has also been made in increasing access to ART regimens for pregnant women to prevent transmission of the virus to their child, in making testing and counseling more available, and in supporting male circumcision, which reduces HIV transmission risk, in sub-Saharan Africa, according to the annual report.
Reductions in the cost of first-line ART drugs were an important factor in making treatment feasible; drug costs declined by 30 percent to 64 percent between 2004 and 2007 in low- and middle-income countries. However, the costs of second-line ART, drug regimens used when initial treatment begins to fail, still remain beyond the reach for most in these countries. Prices are also high in a number of Latin American and Eastern European countries.
Among HIV-positive individuals in low- and middle-income countries who are on stable ART regimens, morbidity and mortality rates can approach those seen in high-income countries.
Nevertheless, the overall HIV/AIDS mortality in countries to the south remains significantly higher than mortality seen in countries in the north, Dr. De Cock noted.
This is partly explained by the fact that HIV-infected people in low- and middle-income countries are usually diagnosed very late in the course of infection, he said. Some patients are diagnosed and then don't receive ART. In other cases, once patients are stabilized on maintenance ART, they are lost to follow-up. These are important areas, he added, that require more attention.
However, a large majority of HIV-infected individuals have still not been diagnosed, the report confirmed. The results of a survey of 17 countries reveal that only an average of about 11 percent of women and 10 percent of men had ever been tested for HIV and knew their results. In another 12 countries, an average of 20 percent of people living with HIV/AIDS were aware they were infected.
The vast majority of HIV infections worldwide -- 80 percent -- are still transmitted sexually. Approximately 10 percent of new infections are transmitted by injecting drugs. While sex remains the primary route of transmission in sub-Saharan Africa, injecting drugs is the most common route of HIV transmission in more than 80 percent of the new cases in countries in Eastern Europe and Central Asia.
The largest population of individuals living with HIV in high-income countries is men who have sex with men.
Progress has been made in increasing treatment to prevent maternal-infant transmission. Compared with 2004, when 10 percent of pregnant women with HIV were on ART to prevent vertical transmission, by 2007, the rates rose to 33 percent. Ten percent of pregnant women were tested for HIV in 2005, while testing rates rose to 18 percent by last year.
A lack of sustainable funding is a problem, with the gap between available and needed funds for programs to achieve universal access to treatment and prevention of HIV infection running at about $8.1 billion US.
The lack of a fully functional health care infrastructure also remains a barrier to treatment in many countries, as does a shortage of health care workers. "Brain drain" is a problem, with many health care professionals seeking better positions in other countries. HIV/AIDS mortality has also reduced the number of available health care workers and other professionals in many countries, especially in sub-Saharan Africa.