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HIV/AIDS treatment programmes using drug cocktails that are standard in the industrialised world are proving less effective in developing countries, says a study published in The Lancet today (10 March).

It shows that people taking the cocktail, known as HAART, are more likely to die in the first few months of treatment if they live in poorer countries.

The authors say this is partly because patients are diagnosed later in such countries, but also because the cost of the drugs means they are not always taken in the way they should be.

Making drugs available for free would reduce the loss of life, they say.

HAART, or Highly Active Antiretroviral Therapy, is a combination of three or more drugs that target the HIV virus in different ways.

Recently there has been a scaling up of international efforts to make HAART available worldwide: between 2003 and 2005, the number of people treated doubled to a million, according to the World Health Organization.

But while HAART is the standard HIV/AIDS treatment in industrialised nations, the cost of the drugs involved puts it beyond the reach of most patients in developing countries, where 90 per cent of people with HIV/AIDS live.

The researchers, led by Matthias Egger of the University of Berne, Switzerland, compared a network of 18 HAART programmes in Africa, Asia and South America with a similar network of 12 HAART programmes in Europe and North America.

They found that patients in low-income countries had weaker immune systems than those in developed countries, and had more advanced diseases when they started treatment.

The researchers say this highlights the need for patients to be diagnosed and have their eligibility for HAART assessed. They add that if the supply of drugs is interrupted, or the patient runs out of money to pay for them, the treatment is less effective so drugs should be made available for free.

Rebecca Baggaley of Imperial College London says the study is a "vital piece of work".

"Previous reports of small pilot projects have tended to conclude that outcomes are as good as in industrialised countries," she says. "But these projects have represented a gold standard of care that would never be enjoyed by most patients in large-scale programmes."

Baggaley says free provision of HAART is essential but adds that there should also be free drugs against other diseases such as tuberculosis that commonly affect people with HIV/AIDS in developing nations.

Link to full paper in The Lancet*

*Free registration is required to view this article.

Reference: The Lancet  367, 817 (2006)

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