HIV/AIDS treatment in developing countries: the battle for long-term survival has just begun

Over three million people living with HIV/AIDS in the developing world receive antiretroviral therapy (ART). However, the medicines and diagnostic tools available are inadequate to respond fully to their needs. In addition, seven million people are in need of treatment and are still waiting for access.

The public health approach to treatment in resource-limited settings has enabled significant scaling-up of treatment - thanks to fixed-dose combinations and to the lower prices of first generation treatments. But this approach has also come at the cost of compromise. For example, stavudine-containing regimens, no longer recommended in well-resourced settings because of side effects, are still widely used in resource-limited settings. In addition, clinical algorithms and CD4 counts are still common methods to diagnose treatment failure even if these have proven to be unreliable.1,2 In most resource-poor settings, since viral monitoring is not available, patients and medical staff are only alerted to resistance when patients suffer from opportunistic infections. This is no longer acceptable medical practice.

It is now time to invest in improving the public health approach. Treatment scale up must continue so that more people in need receive treatment and care. Support for universal access to treatment has been repeatedly confirmed by the international community. Clearly, the promise of universal access cannot be abandoned when only 30 percent of those in need have been reached.

At the same time, ambitions must be expanded for those already on treatment to increase their chances of long-term survival. If we do not respond to evolving medical practice with improvements in drugs and monitoring, we will be guilty of maintaining a sub-optimal status quo.