Treatment Interruptions Raise Fears of HIV Supervirus

Recent pharmaceutical company deals for cheaper AIDS drugs stand to increase the number of patients able to get treatment in Ivory Coast and other African countries, which are home to 26.5 million of the world's 37 million HIV-positive people. But doctors and researchers in Ivory Coast say few patients -- even if they can afford the drugs -- are managing to stick to the strict pill-taking regimes without interruption.

Ivory Coast subsidizes the cost of AIDS treatment for its poorest citizens, who pay just $14 a month for combination therapy -- but only about 1,000 patients of the nation's 1 million HIV-infected persons are receiving treatment. Recent price cuts by drug makers will enable Ivory Coast to triple the number of people on medication over the next year.

But compliance remains a big issue: "It is clear that if you interrupt the treatment regime and start getting sporadic changes in the virus, patients will actually start facing greater problems," said Phil Thomson, spokesperson for pharmaceutical giant GlaxoSmithKline. Auguste Blibolo, a medical researcher at the Institute for Development Research in Abidjan, tracked the treatment of 11 HIV patients in 1998 and 1999. He found that no patient was able to stick to the regime without missing at least a few days of treatment, and nine repeatedly went without pills for more than a week at a time.

In Africa, the compliance problems Western patients face are complicated by economic constraints, social stigma and a severe shortage of medical facilities. Still, the biggest obstacle has been government delays in releasing funds to order new stocks of pills, said Nicole Boni, head of UNAIDS in Ivory Coast. Last year, 13 members of one AIDS support group in Abidjan died when key drugs ran out for three months.

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