Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

The World Health Organization (WHO) estimates that today, 6 million HIV-infected people in resource-poor settings are in immediate need of highly active antiretroviral treatment (HAART). However, only 230.000 are actually receiving the medicines and just 25.000 of them are living in sub-Saharan Africa^*. Up to recently, the high costs of the HAART medicines were prohibitive for large-scale implementation of AIDS treatment programs. However, due to the Accelerated Access Initiative (AAI), the prices of branded drugs have been downscaled to 5-10% of their original high levels. Moreover, generic HAART medicines have become available at even lower prices and it is envisaged that these generics will soon become very important in resource-poor settings. With the introduction of HAART at a larger scale, the need for correct laboratory monitoring will drastically increase. The most specific laboratory markers in this respect are the CD4 T-cell counts and the viral load. These tests are important for determining the moment of initiation of HAART, the success or failure of a given HAART regimen and finally the prediction of the occurrence of opportunistic infections. Today, the costs of HAART laboratory monitoring equal or even surpass the costs of treatment. Prices in the order of $25 for a CD4 T-cell test and $150 for a viral load measurement are rule rather than exception in Africa. However, there are alternative ways of performing these tests, which substantially reduce running costs and costs of investment, simplify laboratory procedures, reduce coldchain dependence, increase laboratory action radius and facilitate maintenance issues. In the current presentation an overview will be given of the most recent developments in the fields of CD4 T-cell enumeration and viral load measurement pertinent to application in resource-poor settings.

^* Scaling up antiretroviral therapy in resource-limited settings: Guidelines for a public health approach. Executive summary, WHO Department of HIV/AIDS, April 2002.

Presenting author: Tobias Rinke de Wit

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2002-11-17
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