HIV/AIDS Physician-Scientists, Advocates Call for Bold HIV Treatment Goals for PEPFAR

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Physician-scientists working on the frontlines of the HIV/AIDS epidemic today urged the White House to set bold new HIV treatment targets for PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief.

The Center for Global Health Policy joined with a coalition of other organizations—including HealthGAP, amfAR (the Foundation for AIDS Research), the Treatment Action Group, and The AIDS Institute—in calling for PEPFAR to reach 6 million people with antiretroviral drugs by 2013 and 7 million by 2014.

The Global Center and these other organizations, part of the Global AIDS Roundtable Treatment Working Group, detailed this HIV treatment imperative in a recent memo to US Global AIDS Coordinator Eric Goosby, MD.

The memo comes as the Administration crafts two related policy positions. First, the Administration is now preparing its Congressionally-mandated five-year global AIDS strategy, including treatment goals and funding levels for fiscal year 2011. And second, in the coming months, the White House is expected to release the details of its Global Health Initiative, which some fear will outline a shift away from AIDS toward other global health priorities.

HIV/AIDS experts say new attention to child and maternal health is welcome and necessary, but it cannot come at the expensive of continued scale up to combat the AIDS epidemic. For one thing, HIV/AIDS in inextricably linked to child and maternal health. In Sub‐Saharan Africa, antiretroviral drugs are critical to addressing maternal and child mortality, and robust scale-up of ARVs will mean millions of women’s lives saved from HIV and tuberculosis. It will mean fewer AIDS orphans and fewer HIV-positive babies.

“HIV remains the largest cause of maternal mortality in some countries and community‐wide coverage of ART is increasingly being shown to decrease non‐HIV infant mortality, poverty, and deaths from diseases like TB,” the memo to Dr. Goosby says. “It is also important to note that Lantos‐Hyde prioritizes scale‐up of PMTCT programs and expansion of ART treatment for HIV‐infected children—priorities that will not be realized in the absence of increased investment in ARV treatment and ambitious treatment targets.”

The call for strong new PEPFAR treatment targets also comes as the scientific case for earlier and broader initiation of antiretroviral therapy gains significant steam. As we noted in a post last week on this topic, the WHO may soon revise its treatment guidelines to reflect the scientific consensus that earlier initiation of ART significantly increases an HIV patient’s chances of survival. We also know that the best way to stave off tuberculosis-related deaths in HIV-positive individuals is to put those patients on ART.

“The rapid scale up to provide antiretrovirals to millions of people through PEPFAR and other programs has made AIDS a manageable chronic disease in many resource-constrained environments,” said Kenneth Mayer, MD, co-chair of Global Center’s scientific advisory committee and a professor at Brown University, where he directs the AIDS Program. “However, the majority of people who need life-saving treatment are not receiving it. With data suggesting that earlier treatment may prevent long-term consequences of HIV disease and may make HIV-positive people less infectious, there is increased urgency to expand access to these medications.”

The memo to Dr. Goosby notes that these aggressive new targets will allow the U.S. to continue its strong leadership in combating global AIDS and can easily be reached if the funding for global AIDS, included when lawmakers reauthorized PEPFAR last summer as the Lantos-Hyde Act, is actually provided.

PEPFAR could meet or even surpass 3 million people supported on treatment within the next 18 months by some estimates. Experts say setting a bold target for 2013, when PEPFAR will be up for reauthorization again, is a vital signal to the world that progress against the disease will continue.

“HIV/AIDS continues to devastate communities throughout the world,” said Matthew Kavanagh, director of US Advocacy for Health GAP. Kavanagh noted that Congress, in its passage of the Lantos-Hyde Act last summer, demonstrated bipartisan support for expanding AIDS treatment in Africa and explicitly mandated that at least half of bilateral HIV/AIDS funding go to treatment and medical services. “Reaching 6 million people is achievable and affordable. It would be a devastating mistake for the administration to low-ball a treatment figure now with millions still waiting for HIV/AIDS drugs,” Kavanagh said.

In addition to the treatment targets, the Global Center and its coalition partners also urged PEPFAR to move away from the use of toxic d4t‐containing regimens to those with tenofovir. This would save money in the long run, since better drug regimens will likely to lead to better adherence, better treatment outcomes, and a reduced need for more expensive second‐line antiretroviral drugs.

The memo and a news release on the treatment targets will be posted on our website soon.

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