[FLORENCE] AIDS drug treatment programmes can be scaled up effectively in poor areas, and do not lead to the high levels of drug resistance that many had feared, according to preliminary results from Mozambique.
The DREAM (Drug Resource Enhancement against AIDS in Mozambique) programme — part of a national strategy to provide antiretroviral drug treatment (ART) to people living with HIV/AIDS — has also confirmed that state-of-the-art laboratory facilities are an important part of monitoring treatment.
Operated through a Catholic organisation, Sant 'Egidio, the scheme has already made an impact in its first year of operation, Italian researcher Michele Bartolo told an HIV/AIDS conference in Florence, Italy, last week.
According to Bartolo, more than 300 HIV-positive individuals with high levels of virus were given ART as part of the programme. Regular analysis over 12 months showed that ART led to a gradual rise in the number of CD4 cells — the cells that HIV targets for infection— in the patients' blood, and a significant drop in the amount of virus.
Furthermore, 42 out of 44 babies born to HIV-positive mothers remained free of infection after one month, whereas up to one-third of the babies would normally become infected if neither baby nor mother received treatment.
"This dream is starting to come true", said Bartolo, adding that the programme continues to enrol new patients, and has plans for two new laboratories staffed by local people.
Under the programme, a central molecular biology laboratory in the capital Maputo handles up to 3,000 blood samples a month from 13 treatment and care centres around the country. Data is transferred between clinical centres by email, using battery-powered laptop computers to cope with frequent electrical failures.
While the analysis relies on standard — and expensive — equipment, the team are also exploring cheaper alternatives. They are also monitoring the genetic make-up of HIV strains from patients before and after treatment begins, to check for the appearance of drug-resistant strains.
"This shows that it is possible to have a very good programme of monitoring as well as a very good ART programme in developing countries," says Soulemane Mboup, director of the HIV/AIDS programme in Senegal, and president of the African AIDS Network, which is monitoring HIV strains in West Africa for drug resistance.
Many developing countries are expanding ART programmes for HIV/AIDS. In most cases, hi-tech laboratory facilities are not available and treatment decisions are based on clinical signs and infrequent monitoring of CD4 counts, often without testing for the amount of virus or monitoring for resistance.
If conducted carefully, these schemes may control HIV infection effectively, but the ability to monitor for drug resistance provides useful additional information, according to Mboup. For example, he says that his team always tries to assess whether any increase in the virus occurs due to drug resistance or because patients are failing to take their medicine.
Mboub's team have previously found that in a well-organised scheme in Senegal, resistant strains are no more likely to arise in resource-poor countries than in Europe or North America, but that without a well-established programme "the rate of resistance is much higher".