World Health Organization Moves to Make AIDS Drugs More Accessible to Poor Worldwide

Helping clear the way for Western-style AIDS treatment to reach even rural Africa, the World Health Organization (WHO) on Monday released new guidelines describing the drug cocktails that work best, as well as the simplest laboratory tests for the disease. The guidelines intend to show doctors in poor areas how to prescribe powerful triple therapy cocktails safely. In addition, WHO added 12 antiretrovirals to its essential drugs list to encourage price competition between patent-based and generic companies and to prod the latter to make more three-drugs-in-one-pill dosages.

WHO's announcement is also meant to silence several critics: drug industry executives who have argued that triple therapy is too complex and dangerous for poor, illiterate patients; AIDS skeptics who argue that the drugs don't work or are toxic; and experts who confuse doctors in poor countries by overwhelming them with competing drug combinations.

Of the 40 million HIV-positive people worldwide, about 6 million are sick enough to need antiretrovirals now, the WHO estimates. Less than 5 percent get them because of the drugs' cost and the costly tests used in the West to monitor them. The WHO recently convened 100 AIDS doctors from 30 countries to come up with four tiers of minimally acceptable tests, said Dr. Basil Vareldzis, who helped write the guidelines.

The first "absolute minimum" tier includes an HIV test and a hematocrit, which measures red blood cell proportions in blood. Since AZT can cause anemia, without the device "you could run the risk of killing somebody," Vareldzis said. The next "basic" tier includes tests that require equipment -- widely available in most health districts, including those in Africa -- to perform white cell counts and basic liver tests.

The WHO recommendations list which drug cocktails should be tried first. It suggests a mix of AZT (zidovudine), 3TC (lamivudine), plus a third drug like nevirapine or efavirenz or abacavir, depending whether a patient is pregnant or is hypersensitive to abacavir. Additional essential drugs include: didanosine, indinavir, lopinavir, nelfinavir, ritonavir low-dose, saquinavir and stavudine. Zidovudine and nevirapine, already listed for mother-to-child transmission, can now be given to adults.

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