Similarities in antiretroviral therapy efficacy in poorer countries to that in industrial nations

Antiretroviral therapy (ART) programs for treating HIV in developing countries are about as effective as ART programs in developed countries, according to an article in the July 15 issue of Clinical Infectious Diseases, now available online.

Some have raised doubts that countries with extremely limited health care resources can effectively manage the complexities of antiretroviral therapy. But the new review of 10 medical studies on HIV treatment programs in the developing world showed that about 57 percent of patients had an undetectable level of HIV in their blood one year after starting ART, which is comparable to that in the developed world.

Availability and cost of ART medications are often barriers to treatment of HIV-infected people in countries lacking resources. Some countries, like Botswana, have government-funded ART programs that provide free or low-cost treatment to those in need. The article found that cost of medication was a significant factor--six months after ART initiation, nearly 30 percent more patients had undetectable viral levels when they received the drugs at no cost than did those who had to pay.

Lead author Louise Ivers, MD, of Harvard Medical School, was not surprised by the similarities in ART's efficacy in poorer countries to that in industrial nations. "People in developing countries have just as much incentive to get well as in rich countries," she said, adding that, if ART is free, patients' adherence to medication is good. However, "in most poor countries the cost of antiretrovirals is really prohibitive" and "even people who can afford it for a few months may not be able to afford it in the long term," said Dr. Ivers. "This shows that we have to try to find a way to provide free antiretrovirals." She hopes that the results showing a link between free ART and successful treatment of HIV will encourage governments in resource-limited countries to fund antiretroviral clinics for those in need.

All studies included in the review had to meet certain criteria, such as having only adult HIV patients, in order to effectively compare them with each other. Dr. Ivers, who works with HIV-infected patients in Haiti, believes the article's findings would be the same regardless of how many studies were included. "We actually looked at hundreds of studies," Dr. Ivers said, but only selected "the ones that might meet the rich countries' definition of antiretroviral success." However, many of the smaller studies not included "gave narrative descriptions of patients that had done well or gained weight" due to antiretroviral use.

An accompanying editorial by Carlos del Rio, MD, and Frances Priddy, MD, of Emory University, echoed Dr. Ivers' sentiments and emphasized that "as substantial resources become available for treatment in resource-poor countries we must not allow funding for prevention to diminish."