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International researchers this week urged African governments and donors to increase HIV treatment programmes on the continent dramatically. This follows the release of a landmark study that shows infected Africans on antiretroviral (ARV) drugs now live almost as long as those who are HIV negative.
The research was released at the Sixth International Conference on HIV Pathogenesis, Treatment and Prevention in Rome and published in the Annals of Internal Medicine.
This first analysis of life expectancy outcomes among Africans with HIV is the fruit of a collaboration between the British Columbia Centre for Excellence in HIV and Aids in Vancouver, Canada, and the universities of Stellenbosch and Cape Town.
The researchers analysed more than 20 000 Ugandans on ARVs between 2000 and 2009. If the treatment was introduced at the age of 20, it increased life expectancy by almost 27 years, and at 35 by almost 28 years. In Uganda life expectancy is 55 years.
Co-author Mark Dybul, of Georgetown University in the United States, said there was “no reason whatsoever” to imagine the results would be any different in South Africa, which used the same drugs and treatment guidelines as Uganda during the study period.
Ed Mills, the study’s principal investigator, said: “Ten years ago, before treatment was available on the continent, we gave Aids patients in Africa books and told them to write down their feelings and thoughts so that their children could get to know them through these [memory] books once they died. Essentially, we told people to prepare for their funeral.”
But today, said Mills, clinics could treat HIV patients with diseases of old age, such as cardiovascular disorders. “Clinics will have to start stocking high blood pressure medication and rehabilitation services, because older HIV patients suffer from the same non-HIV diseases as everyone else.”
Dybul said the research indicated that African health workers could provide healthcare “every bit as good as in America”, whereas a decade ago there was “an underlying pernicious paternalistic myth that ARV treatment was too complex” for Africans to administer and adhere to.
International Aids organisations estimate that five million Africans receive ARV treatment, while at least five million are in urgent need of it.
Dybul is the former head of the US’s multibillion-dollar President’s Emergency Plan for Aids Relief (Pepfar), the largest ARV donor in Africa. In light of the study he urged donors and governments to intensify treatment efforts because HIV-infected people on ARVs are also far less infectious than those who are not. “If we expand resources now, we have the opportunity to control—and even end—the epidemic,” he said.
But there are concerns that US funding for ARV treatment will decrease substantially. Whereas the Bush administration focused its donations almost exclusively on HIV, with a large portion going to Africa, President Barack Obama’s government plans to focus on maternal and child health in Africa. “We believe this study shows that now is not the time for Pepfar to change focus,” Mills said. “Pepfar should be planning to expand the number of people going on treatment in the long term.”
Mills said the research should also serve as inspiration for African governments to urgently invest in producing antiretroviral drugs. “We need factories in Africa that produce generic ARVs,” he said. “We should build this infrastructure as soon as possible. We need to have trained pharmaceutical scientists who can create the drugs in Africa.”
The study found that the earlier HIV-infected people received ARV treatment, the longer they lived. For each year that a patient started treatment too late, he or she lived eight to 10 years less, said Mills.
The study also showed that HIV-infected men had shorter lives than women. Men tended to visit clinics for treatment only when they fell really ill and, as a result, only accessed treatment at a late stage. Mills said the study should encourage African countries to get infected people into treatment much earlier. Most African governments, including South Africa, provide ARV treatment only when an HIV-infected person’s CD4 count is 250 or below, unless the person is pregnant or has tuberculosis.
Mia Malan works for the Discovery Health Journalism Centre at Rhodes University