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

)