Impact of Long-Term Use of Antiretroviral Therapy in Africa Examined at Symposium

In surprising contrast to early predictions, antiretroviral drugs have become more important in the worldwide public health response to HIV/AIDS than most prevention and intervention strategies. This has been especially true in sub-Saharan Africa, hit hardest by the global HIV/AIDS epidemic, where a dramatic increase in access to treatment has produced better-than-expected results, said Max Essex, chair of the HSPH AIDS Initiative.

Essex and colleagues from Harvard and elsewhere gathered on November 19 at the Joseph B. Martin Conference Center on Avenue Louis Pasteur in Boston for a half-day scientific symposium to explore the impact of long-term use of antiretroviral (ARV) therapy in Africa and the remaining challenges to fighting AIDS.

Essex moderated the event. Dyann Wirth, chair of the Department of Immunology and Infectious Diseases at HSPH, provided opening remarks. Keynote speakers were Jean-Paul Moatti, senior adviser to the executive director of the Global Fund Against AIDS, Tuberculosis and Malaria, and Deborah Cotton, chief medical officer and director for the Center for Strategic HIV Operations Research at the Clinton Foundation HIV/AIDS Initiative.

Said Cotton: “There wasn’t a lot of HIV therapy in Africa in 2000. A lot of beliefs and stereotypes were preventing it from moving forward." Despite the stereotypes, progress has been made.

Preventing and treating HIV infections in children topped the list of concerns for several speakers. Most of the half-million children born with HIV will not survive much past their second birthday, Cotton said.

“But you could ask why, in 2008, [are] any babies being born with HIV when we can prevent it,” Cotton said.

Wafaie Fawzi, professor of nutrition and epidemiology at HSPH, was a panelist. He heads a collaboration in Tanzania that includes researchers at Muhimbili University of Health and Allied Sciences (MUHAS) and the Dar es Salaam City Council. He and his colleagues have been studying the relationship between nutrition and HIV progression. Fawzi and his colleagues showed several years ago that a daily regimen of multivitamins can significantly delay the progress of the AIDS virus in HIV-infected women. Now, a study is under way to test whether multivitamins enhance the therapeutic effects of ARV, he said.

In Nigeria, Phyllis Kanki, professor of immunology and infectious diseases at HSPH, is looking at drug-resistance patterns that are developing in tandem with the scale-up of treatment. Kanki has co-authored a new book with Richard Marlink, professor of the practice of public health at HSPH, called A Line Drawn in the Sand: Responses to the AIDS Treatment Crisis in Africa. The book has been published by the Harvard Center for Population and Development Studies and is distributed by Harvard University Press.

The event was sponsored by the Harvard University Global Infectious Diseases Program at the Harvard Initiative for Global Health; Harvard University Center for AIDS Research; HSPH AIDS Initiative; and HSPH Department of Immunology and Infectious Diseases.

Other speakers included David Bangsberg of Harvard Medical School; Conrad Muzoora of the Mbarara University Hospital, Uganda; Shahin Lockman of HSPH; and Bruce Walker of Harvard University Center for AIDS Research.

--Carol Cruzan Morton.  Photo by Suzanne Camarata.