at the Sixth International Congress on AIDS in Asia and the Pacific (6-10thOctober), Melbourne, Australia.
Advocacy for high quality antiretroviral therapy for HIV-infected people in resource-poor settings was dogged by conflicting messages on the final day of the International Congress on AIDS in Asia and the Pacific (6th-10th October, 2001)
The official Melbourne Manifesto, which was completed through a consultative process during the course of the conference, was amended to include a bold call for treatment access. The Manifesto asserts “the right of all people with HIV to access treatments of their choice to take precedence over patent rights and private profits”. Throughout the Asia Pacific region over 7.5 million people are infected with HIV but less than 1% have access to lifesaving antiretrovirals.
However, the rapporteur for the Treatment and Care stream of the congress seemed to undermine the treatment advocacy undertaken during the conference by endorsing the use of suboptimal therapies in developing countries.
Dr Jinlanat Ananworanich of Thailand told delegates that standards of care must vary in different contexts. “Our team thinks it’s not unethical to accept different gold standards, different standards of care, if we want the best for our patients,” Dr Ananworanich said. This pragmatic approach reflected cost concerns with triple combination therapy as expressed by some delegates during the meeting.
Specifically, Dr Ananworanich condoned the use of dual antiretroviral therapy, citing two retrospective Thai studies which showed no significant immunological benefits of three drugs over two after two years of treatment.*
This put Dr Ananworanich at odds with other keynote speakers who used the ICAAP platform to make strong calls for developed countries to provide triple combination antiretroviral therapy and appropriate health infrastructure in developing nations (see Dual therapy inadequate for resource poor countries yesterday). The superior efficacy and sustained health benefits of triple drug regimens in comparison to dual drug regimens have been established by numerous drug trials and cohort studies.
Dr Ananworanich did use the opportunity to call on pharmaceutical companies to remove restrictive conditions attached to the use of discounted antiretroviral drugs in the Asia Pacific region. In addition, she endorsed the use of CD4 and total lymphocyte counts as adequate monitoring techniques in resource-poor settings and advocated further research into intermittent treatment and low dose treatment strategies to facilitate improved treatment access in developing countries.