HIV Therapy for the Developing World: A Global Health Challenge
Harold W. Jaffe, MD
Department of Public Health
University of Oxford
Oxford, UK
Adults and children estimated to be living with HIV 2006
Total: 39.5 (34.1- 47.1) million
Western & Central Europe
740,000740,000
North Africa & Middle East
460,000460,000
Sub-Saharan Africa24.7 million
Eastern Europe & Central Asia
1.7 million 1.7 million
South & South-East Asia
7.8 million7.8 millionOceania81,00081,000
North America1.4 million
Caribbean250,000250,000
Latin America1.7 million
East Asia750,000
Estimated adult and child deaths from AIDS2006
Total: 2.9 (2.5 – 3.5) million
Western & Central Europe
12,00012,000
North Africa & Middle East
36,00036,000
Sub-Saharan Africa2.1 million2.1 million
Eastern Europe & Central Asia
84,000 84,000
South & South-East Asia
590,000Oceania
4,0004,000
North America18,00018,000
Caribbean19,00019,000
Latin America65,00065,000
East Asia43,00043,000
HIV prevalence (%) in adults in Africa, 2005HIV prevalence (%) in adults in Africa, 2005
Impact of AIDS on life expectancy in five African Impact of AIDS on life expectancy in five African countries, 1970–2010countries, 1970–2010
Life expectancy at birth (years)
Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database.
Botswana
South Africa
Swaziland
Zambia
Zimbabwe
1970–1975 1975–1980
1980–19851985–1990
1990–19951995–2000
2000–20052005–2010
70
65
60
55
50
45
40
35
30
25
20
Estimated Annual GDP Loss Attributed to HIV/AIDS, 1992-2002
Country Loss in US$ (millions)Botswana 270South Africa 7,230Swaziland 102Zambia 127
Zimbabwe 638
International Labour Organisation, United Nations: HIV and Work: Global estimates, impact and response, 2004
Mortality and HAART Use Over TimeHIV Outpatient Study, CDC, 1994-2003
0
2
4
68
10
12
14
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Year
Dea
ths
per
100
PY
00.10.20.30.40.50.60.70.80.9
Pat
ient
s on
HA
AR
T
Patients on HAART
Deaths per 100 PY
Daily Cost of Antiretroviral Drugs 3TC/d4T/Nevirapine
Source Cost
U.S. retail pharmacy1 $39
Low-income countries
(average)2
$00.34
1The Medical Letter 2006;4:67 2UNAIDS, April 2007
The President’s Emergency Plan for AIDS Relief
• Announced January 28, 2003
• 15 focus countries
• Goals:
− Treat 2 million HIV-infected people
− Prevent 7 million new HIV infections
− Provide care for 10 million HIV-infected people and AIDS orphans
Overall budget for global AIDS: $15 billion over 5 years ($10 billion new money)
ARV Therapy in Low and Middle Income Countries: December 2006
0
1
2
3
4
5
6
7
Sub-SaharanAfrica
Latin America andthe Caribbean
East, South andSouth-East Asia
Europe andCentral Asia
North Africa andthe Middle East
(Nu
mb
er
of p
eo
ple
in
mill
ion
s)
Unmet need
Receiving ARV therapy
68% of the total unmet need
Challenges in Implementing ARV Programs in Developing Countries
• Lack of knowledge of HIV infection status
• Need for new care models
• Lack of trained personnel
• Laboratory support
• Corruption/maintenance of supply chain
The Global Challenge of HIV/AIDSUnanswered Questions in the ARV era
• Can a prevention focus be maintained?
• What happens when ARV resistance emerges?
• Can ARV programs upgrade medical infrastructure?
• Will staff and resources be diverted from other critical programs?
• Can ARV programs be sustained?
Estimated total annual resources available for AIDS,
1996–2005
PEPFAR
Source: Lancet, 2006; 368: 526–30
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
9 000
8 000
7 000
6 000
5 000
4 000
3 000
2 000
1 000
World Bank MAP Launch Signing of Declaration of
Commitment on HIV/AIDS
Global Fund
( U
S$ m
illio
ns
)