HIV
ANTIRETROVIRAL TREATMENT

1996 was a pivotal year in the treatment of HIV-1 - with the advent of combination antiretroviral therapy including protease inhibitors, new viral load tests, and information about the kinetics of HIV-1 infection in vivo, it became possible to dramatically slow the progression of the disease, according to the Treatment Action Group, New York (markharrington@aol.com). Treatment of HIV-1 infection is likely to be lifelong.

However, low level antiretroviral treatment could curb the epidemic in sub-Saharan Africa (bobhogg@hivnet.ubc.ca) - with no antiretroviral use between 2000 and 2005 there will be about 276 000 cumulative HIV1 positive births, 2 302 000 cumulative new AIDS cases, and the life expectancy at birth will be 46.6years by 2005. By contrast, 110 000 HIV-1 positive births could be prevented by short course antiretroviral prophylaxis, as well as a decline of up to one year life expectancy. The direct drug costs of universal coverage for this intervention would be US$54m - less than 0.001% of the per person health care expenditure.

The triple combination treatment for 25% of HIV1 positive adults could increase life expectancy by3.1 years and prevent more than 430 000 AIDS cases. Currently the most cost effective, preventatively effective and most easily administered antiretroviral agent is probably single dose nevirapine.

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