Issue No. 595
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18 - 24 July 2002 Issue No. 595 Opinion |
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| Published in Cairo by AL-AHRAM established in 1875 | Recommend this page | ||
Winning the war against AIDS
To mark the opening of the XIVth International AIDS Conference (7-12 July 2002) in Barcelona Luc Montagnier*, co-discoverer of the AIDS virus, and Jérôme Bindé*, outline the actions necessary to contain the spread of the virus
Twenty-one years after the first description of the illness and 19 years after the discovery of the HIV virus, the AIDS epidemic continues to spread throughout the world. More than 22 million have already died. Nearly 40 million people are affected by the virus, one-third of whom are between the ages of 15 and 24 years. Some 95 per cent of people with HIV live in developing countries, and three-quarters in sub- Saharan Africa. In the year 2000, nearly 5.3 million people were contaminated by the virus, 3.8 million of them in Africa. Without HIV, the average life expectancy in Africa would be 62; currently it is 47.
Far from being stabilised, the epidemic, which it is mistakenly assumed is contained in the rich countries, continues to spread. Today, in Southern and Southeast Asia, some 5.6 million people have HIV. According to UNAIDS, more than a million people have been infected in China and, at the rate the epidemic is propagating, this figure could exceed five million by 2005. The Russian Federation is threatened by the explosion of the scourge if the trend towards an annual doubling of contaminated people holds. In a number of regions, the statistics themselves are deficient or under-estimated. If radical measures are not taken, the pandemic could kill more than 100 million people between now and 2010.
The sick are in the South, and the treatments in the North: the phrase has gone round the world. And it is true that the rich countries account for only four per cent of the people with HIV but spend 92 per cent of the funds used for preventing and treating AIDS. For 20 years now, the North-South gap has continued to grow. However, these figures are deceiving, for they bring illusory security to the populations of the rich countries. There will be no quarantine line against AIDS. In the most developed countries, the infection remains rampant. Owing to the limits of treatments and the slackening of prevention, it could once again increase in the near future.
So, should we give up? Certainly not. Obviously, there is no magic formula capable of eradicating the epidemic. But neither is AIDS a destiny. We have lost a number of battles against it, through negligence, lack of anticipation, prevention and long-term political will. But we have not lost the war. And it is indeed a matter of war: we must declare war on AIDS. If there is one scourge that threatens world civilisation, this is it. The AIDS epidemic has, in fact, become a major issue of international security. Moreover, it threatens the development of nations and the very idea of progress. We can win this war if we give ourselves the means.
It is first necessary to reaffirm that the policies of prevention, education and information are vital to curbing the scourge. One must recall the diversity of the advance of HIV in the world. While 16 countries of sub-Saharan Africa have announced a prevalence amongst adults greater than 10 per cent there remain 119 countries on the planet where it is less than one per cent. This diversity allows us to hope that the scourge may be stopped, as long as massive education, information and prevention campaigns are implemented. In Brazil, Thailand and even in Uganda and Cambodia, infection rates are dropping.
But such campaigns cannot suffice. As was emphasised by Peter Piot, executive director of UNAIDS, "prevention alone, without access to treatments, is no longer acceptable". The experience of the World Foundation for AIDS Research and Prevention and UNESCO, which have been co-operating in this area for more than 10 years, leads us to believe that the efforts and investments, both public and private, must be directed along three priority lines: access to antiretroviral treatments, the development of a preventive vaccine and the creation of the structures necessary for prevention, treatment and research programmes in those countries that are hardest hit.Access to antiretroviral treatments, first of all. The experience acquired over the past six years in the wealthy countries shows that the mortality rate of patients infected with HIV has been reduced considerably through continuous antiretroviral triple therapy. It is therefore ethically justified, as UNESCO requested in its 1999 world future-oriented report, The World Ahead: Our Future in the Making, to make these medications accessible to all patients of the South who need them. The Pretoria trial turned the spotlight on the battle between those who favour the rights of patients and those who put forward the right to health. The World Fund, launched by the G8 and the UN, aims at increasing the access of southern patients to the therapies. Granted, one can be delighted that the principle of national urgency is beginning to assert itself, that the director general of the WTO himself pleaded for the setting up of "differentiated price" laboratories, and that the large laboratories are beginning to accept the principle of generic medications for the poorest countries.
However, the problem of the cost of these antiretroviral treatments is resolved only in part by the lowering of the price of medications. The triple therapies also call for considerable logistic investments, the tests for the follow-up treatments are expensive, and the duration of treatments, unlike those that are used for treating other chronic illnesses such as tuberculosis, is indeterminate. Any interruption of the treatment brings with it an increase in the plasmatic viral load. In addition, the limits of the antiretroviral treatment are known: important secondary effects, the emergence of mutants of the virus that are resistant to treatment, and the difficulty of long-term observation of the treatment. It is therefore necessary to launch clinical tests to develop less expensive and less toxic relay treatments that would make for a lasting decrease in the viral infection. Here, the research paths are multiple. In particular, it is advisable to favour specific antiretroviral immunotherapy, the rational use of antioxydants and immunostimulants and the treatment of infectious cofactors.
The introduction of effective treatments in those countries hardest hit by AIDS would have three beneficial effects: it would reduce hospital stays and mortality rates resulting from opportunistic infections; it would lower the transmission of the virus, since treated patients are less contagious; and it would increase the effectiveness of prevention through information, and favour massive screening. Some 95 per cent of individuals infected by HIV do not know it and often do not wish to know, in the absence of any prospect of treatment.
A second line of priority action is the development of a preventive vaccine. A vaccine costs much less than a medication. Considered the pathway to arresting an epidemic, the development of this preventive vaccine has turned out to be difficult due to the variability of the virus, its genital transmission and difficulties of testing. Moreover, it is probable that the vectorisation of the virus by proteins or mycoplasma membranes plays an important role in its sexual transmission. If this is the case any vaccine, in order to be effective, would have to include mycoplasma proteins in addition to viral proteins: that implies advanced epidemiological studies for identifying the mycoplasmas, which can vary from one geographical area to another. Recently, a project of vaccinating children born of HIV-positive mothers was undertaken by Professor Montagnier's team, in collaboration with the teams of Professors Vittorio Colizzi and Robert Gallo and African teams, and thanks to financing from the Italian government.
The third course of priority action is the creation of structures necessary for prevention, treatment and research programmes in those countries that are hardest hit, ie, for the most part, in the South and East. While, in fact, the laboratories of the wealthy countries have an important role to play in the aforementioned innovative research, the fact remains that the essentials must be carried out on the spot, in the countries most affected by the scourge: clinical tests, experimentation with plant extracts having antioxidant or immunostimulant properties, laboratory follow-ups, identification of cofactors. The political will of governments of course constitutes a necessary condition for the creation of such structures; international support is also essential. It is thus that the World Foundation for AIDS Research and Prevention created, under the aegis of UNESCO and with the support of the Ivory Coast government, the Abidjan Integrated Centre for Bioclinical Research (CIRBA), which combines prevention through education, treatment of patients, and laboratory work. We propose that every country concerned create or develop such a reference centre that could then extend out towards mobile units located in rural areas. It is only by combining prevention, research and treatment in the same place that we will begin to win the war against AIDS.
Luc Montagnier is president of the World Foundation for AIDS Research and Prevention, the co-discoverer of the HIV virus and author of, amongst others, Virus.
Jérôme Bindé, director of the Division of Foresight, Philosophy and Human Sciences at UNESCO, is the principal co-author of The World Ahead: Our Future in the Making and Keys to the 21st Century.
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