HIV and Aids

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Good news for those attempting to extend antiretroviral treatment to the many millions of people with HIV in developing countries who need medicines but do not receive them.

An extensive study over six years in Uganda and Zimbabwe supported by the UK’s Medical Research Council in Africa suggests that up to a third more patients could be offered treatment, even given existing stretched domestic resources, thanks to a simple trade-off.

The Dart study, published in the latest issue of the Lancet, suggests that regular laboratory monitoring for toxic effects is costly and unnecessary, diverting funds that could instead be used to provide more drugs to patients at an earlier point in the development of the disease.

The researchers, led by Diana Gibb, argue CD4 testing, to measure the breakdown of the body’s immune response, should take place after two years’ treatment to determine whether to switch to more expensive “second-line” therapies.

What are the prospects for improving prevention and treatment of HIV, what more needs to be done and how can we balance efforts to tackle the infection with other health and development priorities?

Email a question now to for

Michel Kazatchkine, executive director of the Global Fund to fight Aids, TB and Malaria, a doctor and France’s former Aids ambassador and
Peter Piot, head of the Institute for Global Health at Imperial College, London, and former executive director of UNAids, the United Nations’ Aids agency

They will post answers to your questions on this page:

On Tuesday December 1, betweeen 17:00 and 18:00 GMT

Andrew Jack, the FT’s pharmaceutical correspondent, talks to Rifat Atun, director; strategy, performance and evaluation cluster; the Global Fund to fight Aids, TB and Malaria

Andrew Jack, pharmaceuticals correspondent, considers the commercial implications

Scientists on Thursday announced a breakthrough in the search for a vaccine for HIV/Aids after a testing programme in Thailand found that an experimental drug had cut the risk of infection by 31 per cent.

Read full FT coverage on

Margaret McCartney

In his illuminating book, Three Letter Plague, South African writer Jonny Steinberg describes the complex reasons why people at high risk of HIV do not take up the offer of testing. Steinberg follows a young man, Sizwe Magadla, who lives in a small, poor village. Magadla is due to get married, and his fiancée is pregnant. He owns a shop, which lends him enormous social standing. But should he test positive, he fears his marriage plans would be cancelled and his shop’s custom ruined. Witchcraft and curses are used to explain illness and medical problems; the cultural fabric wreathed around HIV is made of shame and fear.

When testing comes to the village, rapid test kits are used, which check for antibodies to HIV in a similar way to blood tests. Sexual health clinics often have trouble getting people to return for test results, so doing everything in “one stop” is highly attractive. Many clinics in the developed world find the rapid tests popular, since oral swabs mean no needles.

However, there is a risk of false positives. This occurs when the test confuses the antibodies made in the presence of HIV with other similar antibodies. The test “misreads” them, and reports the presence of HIV when there is none. But the number of false positives depends, at least in part, on the prevalence of the disease.

The remainder of the article can be read here. Please post comments below.

Pharmaceutical companies should grant rival manufacturers the right to produce their HIV medicines, a group of MPs will recommend today in the UK.They should also publish independent audits of their efforts to increase access to treatment as demand surges in the developing world, the MPs will say.

New efforts by companies as well as government donors will be needed to provide better access to more expensive HIV antiretroviral medicines required by more patients in the future, says the report by the all-party parliamentary group on Aids.

“We are sitting on a treatment time bomb. We must reduce the price of second-line medicines and less toxic first-line medicines before millions need them. We cannot sleepwalk into a situation where we can only afford to treat a tiny proportion of those infected,” David Borrow, who chaired the group, said.

The report estimates that the number of people needing HIV drugs globally by 2030 will be 55m, compared with 4m today. The figure could be higher if treatment guidelines change.

It endorses a “patent pool” currently under discussion between several drug companies and Unitaid, the French-led international treatment funding agency, whereby manufacturers would agree to allow low-cost generic producers to make their patented products in exchange for a modest royalty.

GlaxoSmithKline, the UK pharmaceutical group, has supported a pool to provide access to its experimental compounds to outside researchers studying treatments for “neglected” tropical diseases. But the company has so far ruled out doing this for its existing HIV medicines.

The World Congress of Science Journalists has been meeting in London this week with workshops bearing such promising titles as “Swine flu or whine flu?” and “A drought or a flood: climate change reporting around the world?”

At a session I participated in: “Is the growing influence of PR on science journalism in the public interest?,” bad science debunker Ben Goldacre lambasted the assembled journalists for having “blood on their hands” in irresponsibly reporting pseudo science, while John Clare from Lions Den Communications, defending the PR industry, argued that his own enthusiasm to stress the potential benefits of new medicines was typically dampened by pharmaceutical industry clients’ cautious scientists and careful lawyers.

My own conclusion? PR is not necessarily “worse” in health than in many other fields. It can be bad when it hypes or deceives, but also a force for good, such as when it spreads the word and adds pressure for increased access to medical treatment in the developing world.

Health and science blog (Archived)

This blog, part of the FT's health series, is a forum for readers interested in the science, policy, management, technology, business and delivery of healthcare.

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About our regular bloggers

Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog:

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow