More than 95 percent of HIV-infected people live in resource-poor nations -- and only a fraction of the people have access to the potentially lifesaving treatment. This study evaluated the effectiveness of combination ARV treatment in decreasing HIV disease and death. With more than one year of follow-up for clinical and laboratory outcomes and two years of follow-up for survival estimates, the majority of enrolled patients on ARV treatment experienced favorable clinical outcomes, including improved CD4 counts, decreased viral load and weight gain comparable with other successful care and treatment programs in the developed world.
"This data confirms what we are starting to see throughout the developing world. Patients will do fine regardless of social and economic status, provided the necessary infrastructure and funding are in place," said Richard Marlink, M.D., senior author of the article and professor in the Department of Immunology and Infectious Diseases at Harvard School of Public Health (HSPH).
The clinical data was collected from a public-private partnership between the Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP) and the Infectious Disease Care Clinic (IDCC) at Princess Marina Hospital and funded through Bristol-Myers Squibbs' Secure the Future initiative. Initiated in April 2001, this public sector treatment program led to the development of the Botswana's national program and provided the first clinical outcomes data among ARV-treated adults in Botswana.
"These results underscore the importance of monitoring not only clinical outcomes, but also ARV drug tolerability and toxicity as well," said William Wester, M.D., lead author of the article and research associate, Department of Immunology and Infectious Disease at HSPH. "Patients will respond to ARV therapy, but especially early on in their ARV treatment course, drug toxicity may significantly affect ones' quality of life and drug adherence rates." Results from the study have led to changes in the drug regimen to improve patients' drug adherence and prognosis.
In addition to creating the first public sector ARV clinic, Harvard has used the grant received in 2000 through the Secure the Future program to:
Ø Help build the initial HIV Reference Laboratory in Botswana; and
Ø Initiate the groundbreaking "Adult Antiretroviral Treatment and Drug Resistance Study to examine the three main reasons patients fail ARV therapy: drug resistance, tolerability and adherence. This study is also called the "Tshepo" Study, "Tshepo" is the word for "hope" in Setswana. This study was recently extended through 2007, making it the largest and longest running adult ARV treatment research study in the region.
About the Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education
Established in 1996, BHP is a collaborative research and training initiative between the Government of the Republic of Botswana and the Harvard School of Public Health AIDS Initiative. The BHP conducts epidemiological and laboratory-based research on the prevention of mother-to-child transmission and the genomic analysis of HIV-1C, the viral subtype predominant in southern Africa. Research is also conducted on the design and development of an HIV-1C vaccine and on the susceptibility and resistance to antiretroviral drugs. The Partnership also serves as a training facility for Botswana's future researchers and laboratory technicians and is home to various educational efforts that provide multidisciplinary, sustainable and standardized training in HIV and AIDS care crafted for Botswana's health professionals. For more information, visit http://www.bhp.org.bw.
In 1999, Bristol-Myers Squibb and its Foundation launched Secure the Future, the first and largest corporate commitment of its kind to fight and help alleviate the HIV/AIDS crisis among women and children in sub-Saharan Africa. Over the years, the public-private initiative has grown in size and scope to encompass nearly 200 grants totaling $150 million. Secure the Future provides medical care and research, infrastructure- and capacity-building and community outreach and education in nine hard-hit countries in southern and West Africa. For more information, visit http://www.securethefuture.com/
In addition to its commitment in Africa, the Bristol-Myers Squibb Foundation funds programs through its Global HIV/AIDS Initiative in Thailand, Vietnam, Mexico, Russia, the Ukraine and France. See http://www.bms.com/sr/philanthropy/data/globhiv.html/
Harvard School of Public Health is dedicated to advancing the public's health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 900-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: www.hsph.harvard.edu
Journal
JAIDS Journal of Acquired Immune Deficiency Syndromes