HIV This Week

Calmy A, Pizzocolo C, Pizarro L, Brücker G, Murphy R, Katlama C; Strategies in Resource-Limited Settings Working Group. The marriage of science and optimized HIV care in resource-limited settings. AIDS. 2008;22(17):2227-30.

Large-scale HIV management in resource-limited settings has been remarkably successful in a relatively short time frame. Once combination antiretroviral therapy became more universally available, national treatment programs were able to provide much of the needed therapy, originally prioritized towards patients with the most advanced and symptomatic disease. The current worldwide expansion of antiretroviral therapy is due to a large broad-based international effort in financing the antiretroviral drugs and infrastructure required for delivering treatment and care. The fears that HIV treatment would detract from other healthcare concerns or lead to widespread drug resistance have been unfounded but important treatment-related issues remain to be addressed immediately by relevant scientific communities. The fundamental scientific concerns fall into two categories: the comprehensive approach to care and treatment management in settings in which resources are limited, and the diversity of a variety of populations who are predominantly women, have heterogeneous viral subtypes and have exposure to different environmental co-pathogens. There is an urgent need to link science and clinical practice wherever it is taking place. We need to learn more about optimal treatment choices and monitoring schemes appropriate in diverse resource-limited settings. Relevant clinical data that are urgently needed include drug efficacy in genetically diverse populations, the most cost-effective and efficient monitoring of therapy, and interactions with drugs to treat common co-infections and diseases. Transfer of competencies must be done as this is essential for operational research. In addition, we must promote and strengthen national reference centres and develop high level skills for the next generation of scientists and clinicians. The international scientific community must address this urgent need with academic, social, scientific, and economic support for the necessary critical research and training so desperately needed.

Editors’ note: This is an urgent call for more science, more science capacity-building, and more operational research competencies transfer to enable clinical data collection, monitoring, analysis, and evaluation at the service of improved care. Key questions to address include how to improve adherence, when to switch therapies, optimal treatment for pregnant women, and important drug-drug interactions with anti-tuberculosis and anti-malarial agents.