Marco Vitoria

Fighting against AIDS: the Brazilian experience.

Brazil was among the countries to be the earliest and the most intensely affected by the AIDS epidemic. After the first AIDS case was reported in 1982 [1] new cases sky-rocketed to more than 10 000 in the beginning of 1990 [2]. In that year the World Bank estimated that Brazil would experience 1 200 000 HIV infections by the year 2000 explicitly expressing the fear that the epidemic would then be totally out of control. However a recent estimate by the Brazilian Ministry of Health (MoH) has reduced that number to under 600 000 and all AIDS-related figures are much more encouraging than anticipated a decade ago. The objective of this article is to review the actions taken that have prevented the above expectations. (excerpt)

Antiretroviral treatment in resource-poor settings: the Brazilian experience.

The Brazilian HIV/AIDS drug policy has been highly debated and even criticized, particularly at the time of its implementation by the Government in early 90s. However, after more than a decade of action, the success of the Brazilian response to HIV is evident and recognized worldwide, lying upon a concerted early governmental response, a strong and effective participation of the civil society, a multisectoral mobilization, a balanced prevention and treatment approach and the advocacy of human rights in all strategies, particularly with the policy of wide access to antiretroviral drugs. This policy made highly active anti-retroviral therapy (HAART) universally available since 1996, with logistic and criteria distribution based on regularly updated national guidelines. Approximately 140 000 patients now receive antiretroviral (ARV) treatment through the public health system. As a result there has been a significant fall in morbidity/mortality rates, hospital admissions and costs of treatment, with significant growth in demand for outpatient services and decrease for hospital, home and day-care services. It has also led to improvements in the quality of life for HIV+ individuals and savings in the medical costs, while economic and social related costs also have fallen. The policy of universal access to combined antiretroviral treatment (ART)` in Brazil has been shown to be cost-effective and the financial resources devoted to this initiative represents an economically viable investment. This experience also shows that a well-designed and supported international effort to reduce drug prices and improve health infrastructure could overcomemanyobstaclesinmiddle−incomeandlimited−resourcecountries.

The Global Fight Against HIV/AIDS, Tuberculosis, and Malaria Current Status and Future Perspectives

HIV/AIDS, tuberculosis, and malaria are 3 major global public health threats and cause substantial morbidity, mortality, negative socioeconomic impact, and human suffering. Despite the significant increase in financial support and recent progress in addressing these 3 diseases, important obstacles and unmet priorities remain. Disease-specific interventions have had a considerable impact on improving health systems. However, despite considerable investment, weak health systems, inadequate human resources, and poor laboratory infrastructure continue to be major obstacles to expanding health services. Health system strengthening should be addressed in an integrated approach that includes HIV-, tuberculosis-, and malaria-specific interventions. Investment in strategic information and public health laboratory network capacity strengthening are key actions to expand services to successfully address those diseases in heavily impacted countries.

Highly active antiretroviral treatment as prevention of HIV transmission: review of scientific evidence and update.

Purpose of reviewAn estimated 33 million people are living with HIV and universal access remains a dream for millions of people. By the end of year 2008, four million people were on treatment; however, over five million needed treatment, and in 2007, there were 2.7 million new infections. Without significant improvement in prevention, we are unlikely to meet universal access targets including the growing demand for highly active antiretroviral treatment (HAART). This review examines HAART as a potential tool for preventing HIV transmission. Recent findingsWe discuss recent scientific evidence regarding the treatment and prevention gap, importance viral load and HIV transmission, HAART and HIV transmission, when to start, HIV counseling and testing, modeling results and next steps. SummaryHAART has considerable treatment and prevention benefits and it needs to be considered as a key element of combination prevention. To explore HAART as an effective prevention strategy, we recommend further evaluation of human rights and ethical considerations, clarification of research priorities and exploration of feasibility and acceptability issues.

Expanding ART for treatment and prevention of HIV in South Africa : estimated cost and cost-effectiveness 2011-2050

Background Antiretroviral Treatment (ART) significantly reduces HIV transmission. We conducted a cost-effectiveness analysis of the impact of expanded ART in South Africa. Methods We model a best case scenario of 90% annual HIV testing coverage in adults 15–49 years old and four ART eligibility scenarios: CD4 count <200 cells/mm3 (current practice), CD4 count <350, CD4 count <500, all CD4 levels. 2011–2050 outcomes include deaths, disability adjusted life years (DALYs), HIV infections, cost, and cost per DALY averted. Service and ART costs reflect South African data and international generic prices. ART reduces transmission by 92%. We conducted sensitivity analyses. Results Expanding ART to CD4 count <350 cells/mm3 prevents an estimated 265,000 (17%) and 1.3 million (15%) new HIV infections over 5 and 40 years, respectively. Cumulative deaths decline 15%, from 12.5 to 10.6 million; DALYs by 14% from 109 to 93 million over 40 years. Costs drop

Highly active antiretroviral treatment for the prevention of HIV transmission.

504 million over 5 years and

Adverse events associated with nevirapine and efavirenz-based first-line antiretroviral therapy: a systematic review and meta-analysis.

3.9 billion over 40 years with breakeven by 2013. Compared with the current scenario, expanding to <500 prevents an additional 585,000 and 3 million new HIV infections over 5 and 40 years, respectively. Expanding to all CD4 levels decreases HIV infections by 3.3 million (45%) and costs by

Antiretroviral Therapy in Prevention of HIV and TB: Update on Current Research Efforts

10 billion over 40 years, with breakeven by 2023. By 2050, using higher ART and monitoring costs, all CD4 levels saves

Use of antiretroviral therapy in resource-limited countries in 2006: distribution and uptake of first- and second-line regimens

0.6 billion versus current; other ART scenarios cost

Effect on transmission of HIV-1 resistance of timing of implementation of viral load monitoring to determine switches from first to second-line antiretroviral regimens in resource-limited settings.

9–194 per DALY averted. If ART reduces transmission by 99%, savings from all CD4 levels reach