Faculty Bibliography

Of the 12,058 adults that Medecins sans Frontieres has treated with antiretroviral drugs in 21 countries in Africa, Central America and Asia since 2002, 6,861 received fixed-dose combinations. Since March, 80 percent of the group's new AIDS patients have received fixed-dose combinations. Among the fixed-dose combination recipients, the probability of survival after one year was calculated as 82.4 percent, [Alexandra Calmy] reported. About 60 percent of the deaths occurred within the first three months after therapy began. The deaths occurred largely among patients so ill that the antiretroviral therapy began too late to protect them from the infections that often kill patients as a complication of AIDS. Among the 6,861 fixed-dose combination recipients, there was a significant rise in the number of immune cells, known as CD-4 cells, that are destroyed by the AIDS virus. The CD-4 count rose by an average of 137 cells within in a year, in about half the patients. Because of logistical reasons in treating patients in slums and rural areas in countries like Malawi with bad roads and poor transportation, Medecins sans Frontieres does not routinely monitor each patient with the tests that measure the amount of virus in the blood. Doctors in developed countries routinely use such tests, known as viral loads, to determine the effectiveness of therapy

Of the 12,058 adults that Doctors Without Borders has treated with antiretroviral drugs in 21 countries in Africa, Central America and Asia since 2002, 6,861 received fixed-dose combinations. Since March, 80 percent of the group's new AIDS patients have received fixed-dose combinations. Among the 6,861 fixed-dose combination recipients, there was a significant increase in the number of immune cells, known as CD-4 cells, that are destroyed by H.I.V., the virus that causes AIDS. The CD-4 count rose by an average of 137 cells in a year, in about half the patients. In a separate part of the study conducted in Malawi, Dr. Arno Jeannin's Doctors Without Borders team randomly tested the amount of H.I.V. in the blood of 477 patients who had received fixed-dose combinations there for six months or longer. Of these, H.I.V. could not be detected in 85 percent, showing the overall effectiveness of the fixed-dose combinations

A microbicide is at the top of health workers' wish list to protect those women in poor countries whose husbands won't use condoms. A microbicide would also protect an infected woman's sex partners from infection. The need for a microbicide is even more urgent because there is no vaccine for HIV. 'Microbicides will not be magic bullets, and microbicides probably will never be as effective as condoms,' which are considered nearly 100 percent protective, Dr. Zeda F. Rosenberg, chief executive of the nonprofit International Partnership for Microbicides, said in an interview. For example, Rosenberg said, an ideal microbicide would not kill the bacteria that are normally present in healthy vaginas and that produce hydrogen peroxide, a natural disinfectant. Also, scientists do not want a microbicide to change the acidity of the vagina because it could allow unwanted bacteria to flourish

Experience has taught scientists that there is no guarantee of an effective microbicide. At the AIDS Conference in Durban, South Africa, in 2000, health workers had fully expected that a large trial of a spermicide, nonoxynol-9, would prove that the drug was effective. But the trial showed that nonoxynol-9 may increase the risk of HIV infection rather than protect against it. So scientists have shifted their focus to drugs that specifically aim at separate parts of HIV's life cycle. An ideal microbicide would work in three ways. First, it would kill HIV in the vagina and cervix. Second, the microbicide would prevent any virus that escapes from attaching to a woman's cells, the way HIV starts to infect. Third, for any virus that does enter cells, the microbicide would block an enzyme, reverse transcriptase, that HIV needs to replicate

A microbicide is at the top of health workers' wish list to protect the many women in poor countries whose husbands refuse to use condoms. A microbicide would also protect an infected woman's sex partners from infection. The need for a microbicide is even more urgent because there is no vaccine for H.I.V. An ideal microbicide would work in three ways. First, it would kill H.I.V. in the vagina and cervix. Second, the microbicide would prevent any virus that escapes from attaching to a woman's cells, the way H.I.V. starts to infect. Third, for any virus that does enter cells, the microbicide would block an enzyme, reverse transcriptase, that H.I.V. needs the enzyme to replicate. Viread, a drug made by Gilead Sciences that is prepared as a topical gel, is the only licensed antiviral drug being tested as a microbicide. Viread is a member of the class of drugs known as nucleoside reverse transcriptase inhibitors. The National Institutes of Health is about to begin the second of the three-stage testing system for topical Viread, Dr. [Zeda F. Rosenberg] said

UNAIDS has emphasized the need to put AIDS on the agendas of political meetings such as those of the Group of 8, a coalition of the world's top industrialized nations. At the same time, [Peter Piot] and others have tried to get heads of state to attend meetings so as to combine politics and public policy with the science of AIDS

Although [Kofi Annan] has attended many other AIDS meetings since April 2001, and convened the first-ever General Assembly session devoted to a disease AIDS Bangkok is the first International AIDS Conference that Annan has attended. [Peter Piot]'s United Nations group has stressed the need to put AIDS on the agendas of political gatherings like Group of Eight summit meetings. At the same time, Piot and others have tried to get heads of state to attend meetings like this one to combine politics and public policy with the science of AIDS. The AIDS virus threatens to cause large epidemics in many Asian countries. With 17,000 participants, the largest of any AIDS conference, organizers said they hoped that the meeting would focus more attention on the threat to the continent. Tim Brown, an epidemiologist from the East West Center, said that the injection of drugs has been a major force in spreading HIV in many Asian countries. Piot said drug use was 'a touchy subject for political leaders in any country or culture.' Still, he added, there was 'a timid but growing leadership on AIDS.'

In its first progress report, issued a day before the start of the 15th International AIDS Conference in Bangkok on Sunday, the agency said that an estimated 440,000 people were being treated. That is about twice as many as in 2002 and 60,000 less than the WHO's goal at this point, said Dr. Jim Kim, director of the agency's AIDS program. [Lee Jong Wook] has staked his prestige on the effort, saying that the United Nations agency could not afford to let 3 by 5 fail because 'the collective response to the HIV/AIDS pandemic is the benchmark by which our generation will be judged.' Critics could point to a news conference in Bangkok on Saturday, WHO officials were long on promises and less specific about data concerning the effort that the Geneva-based agency is conducting with a number of government and private groups. For example, the WHO published a table listing the estimated number of people receiving antiretroviral treatment by country for 49 key countries. The total was 327,000. The WHO did not publish the countries with the remaining 113,000, and officials did not provide a list when asked at the news conference. The WHO has said 100,000 workers will be needed to meet the 3 by 5 goal. Since 2001, only about 15,000 workers have been trained in antiretroviral therapy in 32 affected countries. At least 3,000 workers have been trained in the first half of 2004, indicating that the training is gaining momentum, the report said

BANGKOK, Thailand -- The 15th International AIDS Conference began on a disturbing note here on Sunday with the cancellation of a summit meeting of world leaders invited to discuss AIDS, one of the worst epidemics in history. Only one, President Yoweri Museveni of Uganda, accepted, said Dr. Peter Piot, the director of U.N. AIDS, an organizer of the conference. Former Presidents Bill Clinton and Nelson Mandela, as well as Denzel Douglas, the prime minister of St. Kitts and Nevis, and Paul Kagame, president of Rwanda, played prominent roles in the last International AIDS Conference, in Barcelona, Spain, in 2002. Spain's prime minister did not attend. President Thabo Mbeki of South Africa spoke at the opening of the conference in Durban, South Africa, in 2000

The reasons vary. Some countries mistrust donor motivation in pushing co-ordination, he said. Countries may have 'real fears' that donor co-ordination could be used as 'a tool for control.'