World Health Organization, UNAIDS, and UNICEF Release New Report on Global HIV/AIDS Treatment

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World Health Organization, UNAIDS, and UNICEF Release New Report on Global HIV/AIDS Treatment

By Liz Highleyman

Nearly 3 million people in resource-limited and middle-income countries are now receiving antiretroviral therapy for HIV/AIDS, according to a new report released on June 2, 2008, by the World Health Organization (WHO), the United Nations Joint Programme on HIV/AIDS (UNAIDS), and the United Nations Children's Fund (UNICEF).

The report, entitled Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, focuses on the past year of progress in scaling up HIV/AIDS interventions, including the latest figures on HIV prevention, testing, treatment, and related high-priority health issues such as tuberculosis (TB).

By the end of 2007, an estimated 33.2 million people worldwide were living with HIV, 2.5 million were newly infected with the virus, and 2.1 million died of HIV/AIDS.

Among the report's major findings:

Access to treatment:

• Nearly 3 million people in low- and middle-income countries were receiving antiretroviral therapy at the end of 2007.

• During 2007, the number of people receiving treatment increased by about 1 million, or 54%.

• However, only about one-third (31%) of the estimated 9.7 million people in need of antiretroviral therapy worldwide were receiving it.

• Nearly three-quarters (72%) of people receiving antiretroviral therapy - or more than 2 million -- live in sub-Saharan Africa.

• By the end of 2007, 21 low- and middle-income countries provided treatment to more than 50% of those in need, while 9 reached coverage of at least 75% (Bhutan, Botswana, Brazil, Chile, Costa Rica, Cuba, Georgia, Laos, and Namibia).

• About 97% of adults and children taking antiretroviral therapy in low- and middle-income countries were receiving first-line drug regimens.

Women and children:

• Nearly half a million HIV positive pregnant women - or about 33% worldwide -- received antiretroviral drugs to prevent mother-to-child HIV transmission by the end of 2007.

• Approximately 200,000 children with HIV worldwide were receiving antiretroviral treatment.

• However, only 8% of infants born to HIV positive mothers were tested for the virus within the first 2 months of birth.

Co-existing infections:

• An estimated 700,000 HIV positive people developed TB in 2006, accounting for about 12% of all deaths among people with HIV/AIDS.

• 500,000 of the 9 million new cases of TB reported in 2007 were multidrug resistant (MDR TB), with extensively drug resistant TB (XDR-TB) also a growing threat.

• Liver disease associated with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is now a leading cause of morbidity and mortality among people with HIV.

• Of the more than 30 million people with HIV worldwide, an estimated 3 million are coinfected with chronic HBV.

• 4-5 million HIV positive people worldwide are coinfected with chronic HCV, ranging from 25%-30% in the U.S. and Western Europe to 70%-95% in Russia and the Ukraine.

Transmission and testing:

• An estimated 80% of all HIV infections are sexually transmitted, while 10% (30% outside of sub-Saharan Africa) are linked to injection drug use.

• An estimated 3-4 million of the 13 million people worldwide who inject drugs are living with HIV.

• Men who have sex with men continue to represent the largest population living with HIV in most higher-income countries, with evidence of resurgent epidemics in North America and Western Europe.

• Only about 10% of people surveyed in 17 countries had been tested for HIV and knew their results.

• Only 20% of people with HIV/AIDS in 12 countries knew their status.

• Just one-third (35%) of health facilities in 50 reporting countries had access to antiretroviral post-exposure prophylaxis (PEP).

Cost and barriers:

• Between 2004 and 2007, the prices of most first-line antiretroviral drugs decreased by 30% to 60% in low- and middle-income countries, thanks to pharmaceutical company price reductions and increased availability of generic drugs.

• Barriers to more extensive prevention and treatment access include inadequate funding, poor health infrastructure, and a shortage of trained healthcare workers.

While advances in treatment are important, WHO HIV/AIDS director Kevin De Cock emphasized that, "We have to do better with prevention" -- echoing NIAID director Anthony Fauci's previous warning that "we cannot treat our way out of this epidemic." While an additional 1 million people had access to therapy in 2007, an estimated 2.5 million were newly infected.

In order to meet the goal of universal HIV prevention and treatment, the agencies estimated that current funding levels would have to be approximately quadrupled, to $35 billion by 2010 and to $41 billion by 2015.

The WHO/UNAIDS/UNICEF report comes the week before a meeting of the United Nations General Assembly to review progress in the area of HIV/AIDS. On June 10-11, heads of state, senior officials, and representatives of international organizations and civil society will convene in New York to discuss progress toward HIV prevention and treatment goals and the challenges that still lie ahead.

Below is the edited text of a press release from the 3 agencies announcing the report. The complete report is available at http://www.who.int

Nearly Three Million HIV-Positive People Now Receiving Life-Saving Drugs, But Access to Prevention and Treatment Still Lacking For Millions

Geneva and Paris, 2 June 2008 -- The close of 2007 marks an important step in the history of the HIV/AIDS epidemic. Nearly 3 million people are now receiving anti-retroviral therapy (ART) in low- and middle-income countries, according to a new report launched today by the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Children's Fund (UNICEF).

Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector also points to other gains. These include improved access to interventions aimed at preventing mother-to-child transmission of HIV (PMTCT), expanded testing and counseling, and greater country commitment to male circumcision in heavily affected regions of sub-Saharan Africa.

"This represents a remarkable achievement for public health," says WHO Director-General Dr. Margaret Chan. "This proves that, with commitment and determination, all obstacles can be overcome. People living in resource-constrained settings can indeed be brought back to economically and socially productive lives by these drugs."

Millions now accessing treatment

According to report authors, the close of 2007 saw nearly one million more people (950,000) receiving antiretroviral therapy -- bringing the total number of recipients to almost 3 million. The latter figure was the target of the '3 by 5' initiative that sought to have 3 million HIV-positive individuals living in low- and middle-income countries on treatment by 2005. Although that target was not achieved until two years later, it is widely credited with jump-starting the push towards ART scale-up.

According to the report, the rapid scale-up of ART can be attributed to a number of factors, including the:

• Increased availability of drugs, in large part because of price reductions;

• Improved ART delivery systems that are now better adapted to country contexts. The WHO public health approach to scale-up emphasizes simplified and standardized drug regimens, decentralized services and judicious use of personnel and laboratory infrastructure;

• Increased demand for ART as the number of people who are tested and diagnosed with HIV climbs.

Greater access: greater need

Report authors state that, overall, some 31% of the estimated 9.7 million people in need of ART received it by the end of 2007. That means that an estimated 6.7 million in need are still unable to access life-saving medicines.

"This report highlights what can be achieved despite the many constraints that countries face and is a real step forwards towards universal access to HIV prevention, treatment care and support," says Dr. Peter Piot, Executive Director of UNAIDS. "Building on this, countries and the international community must now also work together to strengthen both prevention and treatment efforts."

Preventing HIV in children

At the end of 2007, nearly 500,000 women were able to access antiretrovirals to prevent transmission to their unborn children -- up from 350,000 in 2006. During that same time period, 200,000 children were receiving ART, compared to 127,000 at the end of 2006. The difficulty of diagnosing HIV in infants, however, remains a major impediment to progress.

"We are seeing encouraging progress in the prevention of HIV transmission from mother to newborn," says UNICEF Executive Director Ann M. Veneman. "The report should motivate us to focus and redouble our efforts on behalf of children and families affected by HIV/AIDS."

Tuberculosis, weak healthcare systems, hamper progress

Other obstacles to treatment scale-up include poor patient retention rates in many treatment programs and the considerable numbers of individuals who remain unaware of their HIV status, or are diagnosed too late and die in the first six months of treatment.

Tuberculosis is a leading cause of death among HIV infected people worldwide, and the number one cause of death among those living in Africa. To date, HIV and TB service delivery is insufficiently integrated and too many people are losing their lives because they are unable to either prevent TB or access life-saving medications for both diseases.

Report authors warn that future expansion of access to ART is likely to be slowed owing to weak health systems in the worst-affected countries, in particular, the difficulty of training and retaining health-care workers. Health-care systems in regions hardest-hit continue to erode because of 'brain drain' - the migration of skilled health-care personnel to other occupations and to other countries -- and to high mortality rates from HIV itself.

Report authors also emphasize the ongoing need to improve the collection, analysis and publication of critical public health information. Countries, international partners and other sources supply the numbers featured in this report. Despite certain limitations, they constitute the best and most up-to-date estimates of the different elements of the health sector response to HIV/AIDS.

6/06/08

Sources

UNAIDS/WHO/UNICEF. Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector. 2008 Progress Report.

UNAIDS/WHO/UNICEF. Nearly Three Million HIV-Positive People Now Receiving Life-Saving Drugs. Media release. June 2, 2008.