Lax Drug Care Fortifying HIV, TB?

At the recent annual conference of the American College of Chest Physicians in Salt Lake City, an infectious-disease expert warned that greater global access to HIV and tuberculosis medicines must be accompanied by treatment plans that ensure strict compliance. "If we continue to make antiretrovirals available in an uncontrolled, ungoverned system, we will create a maelstrom of drug-resistant HIV and TB, with grim and lethal consequences for decades to come," said Dr. Michael D. Iseman of the National Jewish Medical and Research Center in Denver.

Almost all drug-resistant TB and HIV results from treatment failure and poor compliance, Iseman noted. Both TB and HIV require therapy even during times when there are no symptoms, and the drugs' side effects and toxicity "are not inconsequential," he said. This can prompt patients to skip doses or take breaks in their treatment.

Iseman said he is especially concerned about the goal of universal antiretroviral (ARV) access by 2010 announced at the 16th International AIDS Conference in Toronto. First, it is not realistic, he said. Second, it is "fraught with hazard." "No one can argue against noble ideas," he said, "But I'm skeptical about the ability to deliver."

Part of the problem is that the number of ARV programs far exceeds those that are properly administered, said Iseman. He referred to TB treatment in the 1950s and '60s, when inadequate care "prevented death but fostered more spread and resistance." Similar problems in TB treatment in New York City in the 1980s and '90s, he said, led to "low cure rates, rising morbidity, and soaring resistance."

"Will the impulse to do good be so overwhelming we can't resist making drugs readily available?" Iseman asked. For treatment efforts to become more effective in the developing world, the greatest need is "infrastructure, infrastructure, infrastructure," he said. Action must be tempered by "prudence and awareness of unintended consequences," he warned.

Back to other news for October 30, 2006