By Melissa Healy, Los Angeles Times
8:22 PM CDT, July 18, 2011
In the United States and Europe, antiretroviral drugs have changed HIV infection from an early death sentence to a lifelong but manageable condition. Many international philanthropies have contended that these medications could do the same in poor countries, and have aggressively negotiated lower costs to put them within reach of those in the developing world, where HIV infection rates are highest. But given the challenges to health and hygiene in such countries, it's not been clear that antiretroviral therapy would reverse the shortened life expectancies of the HIV-infected there as they have in the developed world.
A new study brings good news to the 10 million Africans infected by HIV, and the countries that have been decimated by the epidemic: antiretroviral therapy restores patients' life expectancies to close to that of their countrymen and women who are not infected.
The study, published Monday in the Annals of Internal Medicine, finds that in Uganda, after the introduction of widespread antiretroviral therapy financed by the U.S. President's Emergency Plan for AIDS Relief, a 20-year-old taking the cocktail of medications lived, on average, 26.7 more years after starting the drugs, and a 35-year-old could expect to live 28 more years. That brings the average close to Uganda's average life expectancy of 55 years.
"Enabling HIV-infected young adults -- [Africa's] workers and parents -- to live a normal life span is fundamental to returning Africa to its positive health trajectory of a few decades ago," Dr. Deborah Cotton, deputy editor of the medical journal, wrote in an accompanying editorial. "Stunningly, a mere 30 years after one of the worst pandemics in history suddenly appeared, and although still without a vaccine or a cure, we now possess the tools not only to treat but to comprehensively control AIDS in Africa. Despite the challenges, and amid stark and painful choices, somehow the work must be finished."
Of Africa's estimated 10 million infected with HIV, about a third are being treated with antiretroviral drugs.
The study, conducted by a team of researchers from Canada, Switzerland and South Africa, tracked 22,315 Ugandans, 14 and older, who began antiretroviral therapy at one of 11 major clinics and 35 smaller clinics throughout Uganda between 2000 and 2009. Women who took the medication reaped far more benefit than did men: On average, a 20-year-old woman could expect to live 30 more years (32.5 more years for a 35-year-old woman), and a 20-year-old man could expect to live 19.1 more years (or 22 more years if he had made it to 35).
Those who appeared at clinics with a higher CD4 cell count -- indicative of a stronger immune response to infection -- also appeared to gain more years from antiretroviral therapy. And patients older than 55 had the highest mortality rates.
"HIV diagnosis and treatment in resource-limited settings are no longer considered a death sentence," the authors wrote. They cited new research demonstrating that antiretroviral therapy has broader benefits as well, reducing the incidence of tuberculosis, dramatically suppressing HIV transmission and increasing productivity and economic benefits.
Thirty years after AIDS was first detected by U.S. public health officials, a lot's changed. But many challenges remain. Read the Los Angeles Times' retrospective here, and the story of one man's cure here.