MSF reports encouraging results with AIDS treatment
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《英国医生杂志》
Treating people with HIV/AIDS with simplified regimens of antiretroviral medicines is proving effective, even for those with advanced disease living in resource poor settings, new data from the humanitarian aid organisation M閐ecins Sans Fronti鑢es (MSF) show.
A study reported last week at the 15th international AIDS conference in Bangkok, Thailand, showed that simplification of treatment, including use of three-in-one fixed dose combinations of antiretroviral drugs, had allowed MSF to rapidly scale up its AIDS treatment programmes from 1500 patients in 10 countries to 13 000 patients in 25 countries over the past two years.
MSF reported that three factors had facilitated this rapid expansion in the number of patients treated: using fixed dose drug combinations; not doing CD4 cell counts and viral load tests before starting treatment; and giving nurses and clinical officers, rather than doctors, responsibility for treatment. In May 2004, 76% of new patients in MSF projects were treated with a generic, triple, fixed dose pill (d4T/3TC/NVP; stavudine, lamivudine, and nevirapine), taken twice a day.
Observational data on safety and outcomes in 12 058 adults (median age 34 years; 56% women) from 31 MSF programmes in 16 countries showed encouraging clinical and immunological responses. Most patients who started treatment were in advanced stages of AIDS (88% were in WHO stage 3 or 4), but the overall probability of survival at 24 months was 85%. Only 12% of patients were lost to follow up.
Median CD4 cell counts increased with treatment over time, from 101 cells/mm3 at six months to 135 cells/mm3 at 12 months, 193 cells/mm3 at 18 months, and 208 cells/mm3 at 24 months. Patients also gained three to five kilograms during treatment.
Data on viral load are not available in most MSF treatment programmes, and viral load is often not measured routinely in developing countries. However, it was measured in 477 patients who were treated for at least six months in the MSF programme in Chiradzulu, Malawi. Preliminary analysis of the data showed that 407 (85%) had undetectable levels of virus (< 400 copies/ml) after treatment.
Despite the encouraging findings, MSF warned that important challenges remained, including a lack of affordable second line drugs and paediatric formulations. Dr Alexandra Calmy, MSF抯 AIDS adviser, said: "Resistance to first line antiretroviral agents is as inevitable in poor countries as in rich ones. Yet with second line treatments costing as much as $5000 per patient per year in developing countries—15 times the cost of first line treatments—they will simply be out of reach."(London Susan Mayor)
A study reported last week at the 15th international AIDS conference in Bangkok, Thailand, showed that simplification of treatment, including use of three-in-one fixed dose combinations of antiretroviral drugs, had allowed MSF to rapidly scale up its AIDS treatment programmes from 1500 patients in 10 countries to 13 000 patients in 25 countries over the past two years.
MSF reported that three factors had facilitated this rapid expansion in the number of patients treated: using fixed dose drug combinations; not doing CD4 cell counts and viral load tests before starting treatment; and giving nurses and clinical officers, rather than doctors, responsibility for treatment. In May 2004, 76% of new patients in MSF projects were treated with a generic, triple, fixed dose pill (d4T/3TC/NVP; stavudine, lamivudine, and nevirapine), taken twice a day.
Observational data on safety and outcomes in 12 058 adults (median age 34 years; 56% women) from 31 MSF programmes in 16 countries showed encouraging clinical and immunological responses. Most patients who started treatment were in advanced stages of AIDS (88% were in WHO stage 3 or 4), but the overall probability of survival at 24 months was 85%. Only 12% of patients were lost to follow up.
Median CD4 cell counts increased with treatment over time, from 101 cells/mm3 at six months to 135 cells/mm3 at 12 months, 193 cells/mm3 at 18 months, and 208 cells/mm3 at 24 months. Patients also gained three to five kilograms during treatment.
Data on viral load are not available in most MSF treatment programmes, and viral load is often not measured routinely in developing countries. However, it was measured in 477 patients who were treated for at least six months in the MSF programme in Chiradzulu, Malawi. Preliminary analysis of the data showed that 407 (85%) had undetectable levels of virus (< 400 copies/ml) after treatment.
Despite the encouraging findings, MSF warned that important challenges remained, including a lack of affordable second line drugs and paediatric formulations. Dr Alexandra Calmy, MSF抯 AIDS adviser, said: "Resistance to first line antiretroviral agents is as inevitable in poor countries as in rich ones. Yet with second line treatments costing as much as $5000 per patient per year in developing countries—15 times the cost of first line treatments—they will simply be out of reach."(London Susan Mayor)