Irresponsible ARV roll-out may undermine scientific breakthoughs

The Times of London has a good leading article on the approval in Britain of the new AIDS therapy Isentress, which it describes as a 'triumph of human ingenuity'.

The arrival of this new drug is indeed miraculous when considered against an increasingly burdensome drug regulatory environment, and the escalating political risks of investing private capital in AIDS research.

The column lets itself down, though, by reflexively and unfairly laying into the South African government's track record on AIDS treatment.  In early 2007, 140,000 of 983,000 eligible South African patients were receiving antiretroviral treatment — the highest number in the developing world. This number is increasing.

South Africa has attracted controversy because its AIDS treatment programme has not moved as quickly as AIDS activists would have liked (in addition to the health minister’s peculiar comments about beetroot).  However, it has always emphasised proper monitoring of patients and the use of certified drugs.  This certainly takes a while to put in place, but leaves SA well-placed to tackle its AIDS problem.

If African governments roll out treatment before infrastructure is ready, more patients will become resistant to existing drugs, leading to higher treatment costs and more premature deaths.  AIDS treatment programmes need to be rolled out slowly and responsibly, allowing time for the necessary infrastructure to be put into place. 

To blunder into an African country with no health infrastructure and promote an ultra-rapid roll out of treatment, as WHO has advocated in the past, risks quickly destroying the effectiveness of new drugs like Isentress.

That is a betrayal of patients, and a betrayal of the researchers whose hard work has brought us these miracle drugs.