Botswana AIDS drug queues mushroom as patients die
Last Updated: 2004-07-26
GABORONE (Reuters) – Botswana, with the highest per-capita rate of HIV infection in world, is struggling to cope with the demand for treatment, despite pouring much of its diamond wealth into the battle against the killer disease.
"We are faced with an ever worsening, perpetual, insatiable demand," Ernest Darkoh, operations manager for Botswana’s antiretroviral (ARV) drugs programme, told a United Nations meeting on HIV/AIDS in the capital Gaborone on Monday.
"We do not have the staff to deal with it … The critically ill and dying clog the system. Those at the back of the queue we only get around to when they are also dying," he said.
Botswana is seen as a model among African countries in fighting HIV/AIDS, earning plaudits as the first African country to give out free antiretroviral drugs.
Its infection rate of over 37 percent of adults is equalled only by that of nearby Swaziland.
A large, arid country of just 1.7 million people to the north of South Africa, Botswana has funded its campaign through vast dollar earnings from some of the highest-quality diamonds in the world, coupled with massive aid from foreign governments and drug firms as well as private trusts like the Bill & Melinda Gates Foundation.
But Darkoh’s comments revealed that even one of Africa’s richest countries is struggling to come to grips with its AIDS epidemic – a gloomy sign for countries such as neighbouring South Africa, which are only now beginning to roll out their own drug treatment programmes.
Darkoh said efforts to speed drugs to those in need were still inadequate, and the rollout had not been fast enough to keep infected people healthy.
"Phased rollout created an early perverse demand, the answer is to roll out quickly," he said.
"Our phased programme was soon overwhelmed by the critically ill, who travelled from all parts of the country to the few sites which were at first operating. Treating these really sick took five to six times the resources needed for those in the early phases of the disease. We were overwhelmed."
Darkoh runs Botswana’s antiretroviral drugs programme, which since January 2002 has provided drugs to 17,372 people at 18 sites across Botswana, out of a total 27,699 registered as medically eligible for treatment.
A further 6,600 people receive antiretrovirals under private medical schemes, notably by diamond miner Debswana, a joint venture between the government and diamond giant De Beers.
Health Minister Lesogo Motsumi said at this month’s 15th International AIDS Conference in Bangkok that Botswana would meet its target of getting 50,000 on to antiretrovirals by 2005.
That would still be only half the estimated 100,000 people in Botswana who need immediate treatment, but compares with an average of just 4 percent for Africa as a whole.
S. Africa to allow new AIDS drug suit against Glaxo
Last Updated: 2004-07-26
JOHANNESBURG (Reuters) – South Africa will let activists file a new case against GlaxoSmithKline Plc over AIDS drugs, which they say still cost too much for those who need them, competition tribunal officials said on Monday.
British-based GSK and Germany’s Boehringer Ingelheim last year inked an out-of-court settlement in an earlier case, agreeing to grant more licences to firms to produce and import antiretroviral (ARV) drugs.
The deal was approved by South Africa’s Competition Tribunal as a final settlement and a number of new generic licenses have since been granted to South African manufacturers.
But the U.S.-based AIDS Healthcare Foundation (AHF) and several South African activists said they were not part of the agreement, and the tribunal officials said on Monday they would be given 20 days to file a new complaint.
"The voices of the complainants and the patients AHF treats were not heard in the other case," AHF President Michael Weinstein said in a statement.
Attorney Musa Ntsibande said the complaint was intended as a first step toward obtaining an anti-competitiveness ruling, which would allow GSK to be sued for damages.
"They have never admitted liability," he said. "What they have done has been too little, too late."
GSK South Africa issued a statement expressing disappointment at the tribunal’s decision and calling the new complaint "unfounded".
"We are progressing well with the terms of the settlement. We have granted two voluntary licenses for the manufacture and supply of GSK antiretrovirals in South Africa and continue to make progress towards further agreements," the company said.
MILLIONS NEED DRUGS
South Africa has more people living with HIV/AIDS than any other country — an estimated 5.3 million, equal to 13 percent of the world’s infected.
After years of delay the country this year launched a public ARV treatment programme, increasing pressure on drug supplies.
South Africa’s Competition Commission found last year both GSK and Boehringer Ingelheim had a case to answer on anti-competitive behaviour on AIDS drugs and recommended to the tribunal, an enforcement body, they be fined and required to allow the manufacture of generics.
That ruling was set aside by the out-of-court settlement.
Activists said on Monday they would drop Boehringer from the new complaint because they were satisfied with its performance. But they said GSK had not come through on its promise to make generics more widely available.
GSK has granted generic licences to South African drug makers Aspen Pharmacare and Thembalami Pharmaceuticals, a joint venture between Adcock Ingram and India’s Ranbaxy Laboratories.
But activists say the generics are still hard to get and blame GSK for holding the process up.
"We have not yet seen a single pill," said Swazi Hlubi, executive director of the Network of AIDS Communities of South Africa, one of the complainants in the case.
"We want to see evidence that they are coming through, to apply pressure so that the process is sped up. People are dying and we need to get to the root of the problem."
EU launches key Africa AIDS research centre
Last Updated: 2004-07-26
CAPE TOWN (Reuters) – The European Union on Monday launched a research centre in South Africa to help Africa fight the spread of HIV/AIDS, tuberculosis and malaria.
The diseases kill millions of people on the continent annually, with an estimated 3,000 children dying of malaria – a preventable and curable illness – every day.
European Developing Countries Clinical Trials Partnership (EDCTP) executive director Piero Olliaro told reporters in Cape Town the group would fund 18 clinical trials in Africa and nine in Europe over the next three years.
"These are the immediate priorities for the first semester of operations of the EDCTP," he said at the opening of the EU-funded organisation’s Africa office in Cape Town.
Southern Africa suffers the highest HIV/AIDS infection levels in the world. With more than five million living with HIV or AIDS, South Africa has the highest caseload in the world.
Olliaro said the EDCTP, based at South Africa’s Medical Research Council, aimed to boost the quality of studies into the three diseases.
"Regulations and ethics today require that clinical trials be conducted to meet the highest standards. Thus, we must ensure that the capacities exist in Africa to meet these requirements," he said.
The EU has budgeted 3.5 million euro ($4.2 million) in the first year of the trials, and will help set up a clinical trials registry documenting past and present research, Olliaro said.
HIV patients may risk Alzheimer’s
Last Updated: 2004-07-22
PHILADELPHIA (Reuters) – Patients infected with HIV may have a higher risk of Alzheimer’s disease, researchers said on Thursday.
Dr. Cristian Achim of the University of Pittsburgh and colleagues examined the brains of about 160 people infected with HIV and found that two-thirds contained deposits of beta-amyloid protein similar to those seen in Alzheimer’s patients. All the patients had been taking highly active anti-retroviral therapy.
Achim told a news conference his team found "abundant deposits" of the protein in the brains they examined. It was not clear whether the disease or the medications were the cause, he told attendees at the 9th International Conference on Alzheimer’s Disease and Related Disorders.
Achim said the findings would now be tested using brain imaging techniques that can detect the accumulation of beta-amyloid. Alzheimer’s researchers are experimenting with techniques such as positron emission tomography or PET to see if it can help them diagnose Alzheimer’s before symptoms develop.
AIDS mortality higher in women with depression
Source : Am J Public Health 2004;94:1133-1140
Last Updated: 2004-07-21
NEW YORK (Reuters Health) – In HIV-positive women, chronic depressive symptoms appear to increase the risk of AIDS-related death, researchers report in the July issue of the American Journal of Public Health.
Dr. Judith A. Cook of the University of Illinois at Chicago and colleagues note that previous studies have shown an association between depression and immune system suppression and other negative health outcomes. However, the relationship between depression and HIV disease progression is not well understood.
To investigate further, the researchers examined data on 1716 HIV seropositive women who, over a 7.5 year period, paid semi-annual visits to clinics at one of 6 sites.
In all, 147 (9%) died from AIDS-related causes over the course of the study. Other causes, including accidents and non-HIV-related diseases accounted for the deaths of another 147 women.
Women who had chronic depressive symptoms were more than twice as likely to die of AIDS-related causes than were women who had few or no such symptoms. These findings are line with those of another large multi-center study.
Moreover, AIDS mortality was less likely in women who reported mental health service use. Among other factors that reduced mortality were being on a HAART regimen or on non-HAART combination therapy.
Thus, Dr. Cook told Reuters Health, "we now have substantial evidence from two large, multi-site cohorts of HIV-positive women that depression treatment must be part of the best-practice standard of care for women with HIV."
"Antiretroviral treatment alone," she added, "will not address the needs of a significant number of women with HIV." Such therapy, the researchers conclude, "must be augmented by appropriate and sensitive mental health treatment, particularly as HIV disease progresses."
Low-cost alternative for CD4 cell counts found effective
Source : J Acquir Immune Defic Syndr 2004; 36:1006-1010
Last Updated: 2004-07-20
NEW YORK (Reuters Health) – Coulter cytosphere assay is an inexpensive alternative to flow cytometry for measuring CD4 cell counts, a multinational team of researchers from India report.
The need for a "simple reliable and cost-effective immunologic marker" for CD4 assay prompted Dr Pachamuthu Balakrishnan from YRG Care Centre for AIDS Research and Education, Chennai, India, and colleagues to evaluate a manual method commonly used for measuring blood cell counts.
CD4 lymphocyte counts of 122 HIV-positive patients in various disease stages were evaluated using the conventional flow cytometry and the low-cost cytosphere assay using a commercial Coulter manual CD4 kit. In the low-cost method, the blood sample was mixed with monocyte-blocking and CD4-cytosphere reagents and CD4 count carried out manually using a Coulter hemocytometer.
Overall, there was a close correlation of 0.97 between the CD4 counts using flow cytometry and those using the Coulter cytosphere assay, Dr. Balakrishnan and colleagues report in the August issue of Journal of Acquired immune Deficiency Syndromes.
The correlation was most accurate for CD4 counts less than 200 per microliter, with the sensitivity, specificity, positive and negative predictive values being 94.9%, 96.4%, 92.5% and 97.6% respectively. The mean difference in the CD4 cell count between the two methods was only 10 cells per microliter, the researchers note.
Coulter cytosphere assay is cost-effective, requiring only an initial investment of $500 for the microscope and $10 per test as compared to an initial cost of $40,000 and $1000 annual cost for flow cytometry, Dr. Balakrishnan’s team writes.
"The inter- and intrapersonal variability was within acceptable limits and the reproducibility is excellent," Dr. P Balakrishnan told Reuters Health.
As the only requirements are a microscope and a week’s training, the cytosphere assay can be carried out even in primary care settings, he said.
"Hence, the cytosphere assay can be used as an alternate to flow cytometry for estimation of CD4 T-lymphocyte counts, especially in resource-poor settings of developing countries," Dr. Balakrishnan and colleagues conclude.
Source : J Acquir Immune Defic Syndr 2004; 36:1006-1010