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HIV antiretroviral therapy in resource-limited settings: Experiences from Haiti

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Abstract

An unprecedented international effort to expand high activity antiretroviral therapy (HAART) to resource-poor nations has been launched. The World Health Organization (WHO) has created antiretroviral (ARV) treatment guidelines adapted to resource-poor settings. The first-line regimen is two nucleoside reverse transcriptase inhibitors (NsRTIs) and one nonnucleoside reverse transcriptase inhibitor (NNRTI). Therapy is initiated by clinical staging and CD4 T-cell counts when available. Adherence is the responsibility of health care workers. The use of ARV therapy in resource-poor settings faces several challenges, including the poverty of patients, political and social upheavals and violence, social stigma associated with HIV/AIDS, unreliable pharmacy systems, tuberculosis, and lack of trained health care workers. Using our experience in Haiti, we describe how we have addressed these challenges with the goal of increasing access to care for the poor with HIV/AIDS.

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References and Recommended Reading

  1. Pape JW, Liautaud B, Thomas F, et al.: Characteristics of the acquired immunodeficiency syndrome (AIDS) in Haiti. New Engl J Med 1983, 309:945–950.

    Article  PubMed  CAS  Google Scholar 

  2. Joint United Nations Program on HIV/AIDS (UNAIDS): AIDS epidemic update, 2004. Accessible at http://www.unaids.org/ wad2004/report.html. Accessed January 27, 2005. Access to HIV/AIDS epidemiological data for countries where surveillance is done.

  3. Department of Health and Human Services Centers for Disease Control and Prevention: Pneumocystis Pneumonia—Los Angeles. MMWR 1981, 30:250–252.

    Google Scholar 

  4. Barré-Sinoussi F, Chermann JC, Rey F, et al.: Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science 1983, 220:868–871.

    Article  PubMed  Google Scholar 

  5. Fischl MA, Richman DD, Grieco MH, et al.: The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. N Eng J Medicine 1987, 317:185–191.

    Article  CAS  Google Scholar 

  6. Hammer SM, Squires KE, Hughes MD, et al.: A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. N Engl J Med 1997, 337:725–733.

    Article  PubMed  CAS  Google Scholar 

  7. Palella FJ, Delaney KM, Delaney MS, et al.: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998, 338:853–860.

    Article  PubMed  Google Scholar 

  8. Sepkowitz K: AIDS—the first 20 years. N Engl J Med 2001, 344:1764–1772.

    Article  PubMed  CAS  Google Scholar 

  9. World Health Organization: The "3 by 5" progress report, December 2004. Accessible at http://www.who.int/3by5/ progressreport05/en/. Accessed January 27, 2005.

  10. Carpenter CC, Fischl MA, Hammer SM et al.: Antiretroviral therapy for HIV infection in 1996. Recommendations of an international panel. International AIDS Society—USA. JAMA 1996, 276:146–154.

    Article  PubMed  CAS  Google Scholar 

  11. Levi GC, Victoria MA: Fighting against AIDS: the Brazilian Experience. AIDS 2002, 16:2373–2383.

    Article  PubMed  Google Scholar 

  12. Teixeira PR, Vitoria MA, Barcarolo J: Antiretroviral treatment in resource-poor settings, the Brazilian experience. AIDS 2004, 18:S5-S7. A Discussion of the National ARV Program of Brazil, a model program that broke through all barriers by providing free generic ARV to all HIV-positive citizens since 1996.

    Article  PubMed  Google Scholar 

  13. Lanièce I, Ciss M, Desclaux A, et al.: Adherence to HAART and its principal determinants in a cohort of Senegalese adults. AIDS 2003, 17:S103-S108.

    Article  PubMed  Google Scholar 

  14. Phanuphak P: Antiretroviral treatment in resource-poor settings: What can we learn from the existing programmes in Thailand? AIDS. 2004, 18:S33-S38.

    Article  PubMed  Google Scholar 

  15. Weidle PJ, Malamba S, Mwebaze R, et al.: Assessment of a pilot antiretroviral drug therapy programme in Uganda: patients’ response, survival, and drug resistance. Lancet 2002, 360:34–40.

    Article  PubMed  CAS  Google Scholar 

  16. Farmer S, Léandre F, Mukherjee JS, et al.: Community-based approaches to HIV treatment in resource-poor settings. Lancet 2001, 358:404–409.

    Article  PubMed  CAS  Google Scholar 

  17. Adje C, Cheingsong R, Roels TH, et al.: High prevalence of genotypic and phenotypic HIV-1 drug resistant strains among patients receiving antiretroviral therapy in Abidjan, Cote d’Ivoire. J Acqui Immune Defic Syndr 2001, 26:501–506.

    CAS  Google Scholar 

  18. Sidley P: Mbeki appoints team to look at cause of AIDS. BMJ 2000, 320:1291.

    Article  PubMed  CAS  Google Scholar 

  19. Global Fund to Fight AIDS, Tuberculosis and Malaria. http:// www.theglobalfund.org/en/. Accessed November 26, 2004.

  20. Tobias RL: The President’s Emergency Plan for AIDS Relief, U.S. Five-Year Global HIV/AIDS Strategy. Report from the Office of the United States Global AIDS Coordinator. February, 2004.

  21. The World Health Organization: The "3 by 5" initiative, 2003. Accessible at http://www.who.int/3by5/en/. Accessed January 27, 2005.

  22. World Health Organization: Scaling-up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach, 2003 revision. Geneva, Switzerland, 2004. Accessible at http://www.who.int/3by5/publications/ documents/arv_guidelines/en/. Accessed March 2, 2005. Documents are the major guidelines used in resource-limited settings for adults and children.

  23. United States Department of Health and Human Services: Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents, 2003. Accessible at http://aidsinfo.nih.gov/guidelines/. Accessed January 24, 2005.

  24. Nightingale SL: From the (US) Food and Drug Administration. JAMA 1998, 280:1472.

    Article  PubMed  CAS  Google Scholar 

  25. From the Food and Drug Administration, Public Health Advisory for Nevirapine (Viramune).

  26. Deeks, S. Treatment of Antiretroviral Drug Resistant HIV-1 Infection. Lancet. 2003, 362:2002–2011.

    Article  PubMed  CAS  Google Scholar 

  27. Lange, J, Perriens J, Kuritzkes D et al.: What policymakers should know about drug resistance and adherence in the context of scaling-up treatment of HIV infection. AIDS. 2004, 18:S69-S74.

    Article  PubMed  Google Scholar 

  28. Paterson DL, Swindells S, Mohr J et al.: Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection. Ann Intern Med 2000, 133:21–30.

    PubMed  CAS  Google Scholar 

  29. Nemes M, Carvalho HB, Souza M: Antiretroviral therapy adherence in Brazil. AIDS 2004, 18:S15-S20.

    Article  PubMed  Google Scholar 

  30. World Health Organization: Haiti: epidemiological fact sheets on HIV/AIDS and sexually transmitted infections, 2004 update. Accessible at www.who.int/hiv/pub/epidemiology/ pubfacts/en. Accessed Janaury 27, 2005.

  31. World Bank: Haiti at a glance, 2004. Accessible at http:// www.worldbank.org/data/countrydata/aag/hti_aag.pdf. Accessed March 2, 2005.

  32. United Nations Development Programme: Human development index 2004. Accessible at http://hdr.undp.org/reports/ global/2004/pdf/hdr04_HDI.pdf. Accessed March 2, 2005.

  33. Wines: The aristide resignation: exile; the host of aristide is uneasy. New York Times, March 1, 2004. Accessible at http://query.nytimes.com/gst/ abstract.html?res=F30617F93E5B0C708CDDAA0894DC40448 2&incamp=archive:search. Accessed March 2, 2005.

  34. Joint United Nations Program on HIV/AIDS (UNAIDS): Haiti: epidemiological fact sheets on HIV/AIDS and sexually transmitted infections. 2002 Update. Accessible at http:// www.unaids.org/en/geographical+area/by+country/haiti.asp. Accessed March 2, 2005.

  35. L’Institute Haiten de L’Enfance (IHE), MSPP/IHE/GHESKIO/ CDC: Enquete de serosurveillance par méthode sentinelle (ESSMS) de la prévalence du VIH, de la Syphilis, de l’Hépatite B et de l’Hépatite C chez les femmes enceintes en Haïti, 2003–2004.

  36. Deschamps MM, Fitzgerald DW, Pape JW: HIV Infection in Haiti: natural history and disease progression. AIDS 2000, 14:2515–2521.

    Article  PubMed  CAS  Google Scholar 

  37. Koenig SP, Léandre F, Farmer PE: Scaling-up HIV-treatment programmes in resource-limited settings: the rural Haiti experience. AIDS 2004, 18:S21-S25.

    Article  PubMed  Google Scholar 

  38. Tang AM, Graham NM, Saah AJ: Effects of micronutrient intake on survival in HIV type-1 infection. Am J Epidemiol 1996, 143:1244–1256.

    PubMed  CAS  Google Scholar 

  39. Murphy H, Berggren R: Sustained HIV detection and treatment despite conflict in Haiti. Contagion 2004, 1:60–62.

    Google Scholar 

  40. Farmer P: Political violence and public health in Haiti. N Eng J Med 2004, 350:1483–1486.

    Article  CAS  Google Scholar 

  41. Fitzgerald DW, Simon TB. Telling the stories of people with AIDS in rural Haiti. AIDS Patient Care. 2001. 15:301–309.

    Article  CAS  Google Scholar 

  42. Cayemittes M, Placide MF, Barrère B, et al.: Enquête mortalité, morbidité et utilisation des services, Haïti 2001. Calverton, Maryland: Ministère de la Santé Publique et de la Population, Institut Haïtien de l’Enfance et ORC Macro.

  43. Clérismé C: Evaluation du projet pour favoriser l’access aux services de santé visant à la diminuation de la transmission materno-infantile du VIH et des autres infections sexuellement transmissibles. 2003. Port au Prince, Haiti: Fonds de Contrapartie Haiti Canada.

    Google Scholar 

  44. "Dèyè Mòn". Directed by Amelia Shaw. Produced by Agence des Jeunes Producteurs. AJP 2004.

  45. Castro A, Farmer P: Understanding and addressing AIDS-related stigma: from anthropological theory to clinical practice in Haiti. Am J Public Health 2005, 95:53–59.

    Article  PubMed  Google Scholar 

  46. Weiser S, Wolfe W, Bangsberg D, et al.: Barriers to antiretroviral adherence for patients living with HIV Infection and AIDS in Botswana. J Acquir Immune Defic Syndr 2003, 34:281–288.

    Article  PubMed  Google Scholar 

  47. Accessing ARVs: Untangling the Web of Price Reductions for Developing Countries, 6th edition, April 2004. Médecins Sans Frontières. Accessible at www.accessmed-msf.org. Accessed January 24, 2005.

  48. Pape JW: Tuberculosis and HIV in the Caribbean: approaches to diagnosis, treatment, and prophylaxis. Top HIV Med 2004, 12:144–149.

    PubMed  Google Scholar 

  49. Hung CC, Chang SC: Impact of highly active antiretroviral therapy on incidence and management of human immunodeficiency virus-related opportunistic infections. JAntimicrobial Chemotherapy 2004, 54:849–853.

    Article  CAS  Google Scholar 

  50. "Dear doctor" drug-induced hepatitis with marked transaminase elevations has been observed in healthly volunteers receiving rifampin 600 mg once daily in combination with ritonavir 100/saquinavir 1000 mg twice daily" Roche. February 2005.

  51. Kumarasamy N, Chaguturu, S, Mayer KH, et al.: Incidence of immune reconstitution syndrome in HIV/Tuberculosis-coinfected patients after initiation of generic antiretroviral therapy in India. J Acquir Immune Defic Syndr 2004, 37:1574–1576.

    Article  PubMed  CAS  Google Scholar 

  52. Breton G, Duval X, Estellat C, et al.: Determinants of immune reconstitution syndrome in HIV type 1-infected patients with tuberculosis after initiation of antiretroviral therapy. Clin Infect Dis 2004, 39:1709–1712.

    Article  PubMed  Google Scholar 

  53. Centers for Disease Control, In Haiti: Rapport d’evaluation des sites potentials pour la fourniture des traitments antiretroviraux en Haiti, du 1er au 18 juin, 2004.

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Authors and Affiliations

  1. Division of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, 1300 York Avenue, Room A-421, 10021, New York, New York, USA

    Daniel W. Fitzgerald MD

Authors
  1. Alysa Krain MD, MSc
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  2. Daniel W. Fitzgerald MD
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Krain, A., Fitzgerald, D.W. HIV antiretroviral therapy in resource-limited settings: Experiences from Haiti. Curr HIV/AIDS Rep 2, 98–104 (2005). https://doi.org/10.1007/s11904-005-0025-3

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