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Africa: The High Price Of Denial


Developments to Watch

Africa: The High Price of Denial

Drugs, no matter how effective, can fight AIDS only when delivered to the people who need them. On that front, the war against HIV has been a dismal failure. Some 72% of the world's estimated 5.3 million new infections per year are in Africa. Yet virtually no one is getting treatment.

New analyses show this is more than a health catastrophe: The epidemic can cause economic crises and pose national security risks for the U.S. "Africa has no chance of developing without first addressing AIDS, malaria, and other diseases," says economist Jeffrey D. Sachs, director of the Harvard Center for International Development. If these diseases are not controlled, the continent will slow the growth of the global economy. And the societal breakdowns from disease may lead directly to conflicts and mass migrations requiring intervention by the West. "There's a recognition by the CIA and the U.N. Security Council that this pandemic fundamentally threatens U.S. interests," says Sachs. Compared with the huge cost of doing nothing, he says, spending $2 billion to $5 billion to prevent and treat AIDS is a bargain.By John CareyReturn to top

TABLE

The Toll of HIV in Sub-Saharan Africa

3.8 MILLION infected during 200025.3 MILLION living with infections at the end of 20002.4 MILLION deaths during 2000

Data: Joint U.N. Program on HIV/AIDSReturn to top

Genes Show a Way to Predict Risky Side Effects

Resistance isn't the only problem caused by new AIDS drugs. Doctors are realizing the drugs have potentially life-threatening side effects, such as heart disease due to elevated cholesterol. But now scientists are beginning to figure out how the drugs boost cholesterol levels--and the risk of heart problems.

A team led by Dr. Andre Miserez of the University of Basel in Switzerland tackled the problem by searching for the genes affected by so-called protease-inhibitor drugs. They found one that is a key regulator of the pathway that helps control the amount of glucose and cholesterol and other fats in the blood. Significantly, however, the gene comes in two different forms. Some 70% of the population has the version affected by the drugs; the rest escape this dangerous side effect. That makes it possible to use a genetic test to predict in advance who's at risk, says Miserez. And the discovery may enable scientists to figure out how to counteract this side effect--or to design new drugs that don't cause it.By John CareyReturn to top

Heading Off HIV before It Invades

Today's drugs fight HIV by blocking the enzymes the virus needs to copy itself after it gets into cells. But there's a different tack--keeping the virus from entering the cells in the first place. Scientists at Trimeris in Durham, N.C., have developed a drug called T-20, known as an "entry inhibitor" because it prevents the virus from invading. Studies prove it works against viral strains that defeat existing medicines. "Its activity against drug-resistant viruses is very promising," says David Ho, director of the Aaron Diamond AIDS Research Center.

Now, a study shows that T-20 can also give today's drugs a boost against viruses that aren't resistant. In patients getting a powerful four-drug regimen to hold virus levels low, the addition of T-20 reduced viral levels to 10% of what they had been. "We were surprised to see an effect over and above" the reduction produced by the other drugs, says Trimeris CEO Dani Bolognesi.

Trimeris is also developing a second-generation entry inhibitor. And Schering-Plough has found a drug that blocks entry by acting on a different part of the virus. Tests show that attacking both targets may be more effective than attacking either alone.By John CareyReturn to top


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