Tropical disease experts report missed opportunity to transform global HIV/AIDS fight

Global HIV/AIDS prevention and treatment efforts are missing a major opportunity to significantly improve health conditions in poor countries by simply adding low-cost care for the many other chronic and disabling diseases routinely afflicting and often killing these same patients, according to a panel of disease experts who spoke at the annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH).

"People want better health; they do not understand why we silo diseases," said Judd Walson, a global health and infectious disease expert at the University of Washington. "If you die from malaria, you don't care that your HIV was treated. Communities want us to leverage the resources we have to treat and prevent disease as effectively as possible."

Walson and his colleagues on the panel noted that many victims of HIV/AIDS also typically suffer from one or more of about 17 neglected, but burdensome, tropical diseases often called "diseases of poverty" because they prey on the "bottom billion"—the world's poorest people. They include ailments such as trachoma, schistosomiasis, lymphatic filariasis, leishmaniasis, Chagas disease and onchocerciasis, all of which are either insect-borne disease, bacterial infections, or caused by parasitic worms.

Despite the illness and deaths attributable to these diseases, proposed US funding for fighting them was only about $155 million in 2011, or about 3 percent of the $5.6 billion invested in HIV/AIDS efforts. Moreover, the programs often exist in isolation from one another with, for example, many programs restricting support only to antiretroviral drugs to treat AIDS.

Yet tropical disease experts note that in places like sub-Saharan Africa, where neglected diseases affect 1.4 billion people, co-infections with HIV are common. And they see mounting evidence that dealing with multiple diseases at the same time and in the same place is more cost-effective and clinically beneficial.

Walson pointed to a program in Western Kenya that focused on a community suspected of having high levels of HIV but whose remote location made it hard to reach to conduct testing. The program promised access to free bed nets and water filters to those residents who came in for a test. In just six days, some 10,000 residents turned out for the free nets and filters. The result: 1181 people were found to be HIV positive and referred to care while thousands of people gained new tools for preventing malaria and water-borne diseases.

In another example of the potential benefits of targeting multiple problems in a single intervention, a study initially focusing on treatment for onchocerciasis, a parasitic disease also known as river blindness, was broadened to offer insecticide-treated bed nets (ITNs), malaria drugs and vitamin A. The study, which covered an area with 2.35 million people, increased bed net coverage by nine-fold.

Sten Vermund, Professor of Pediatrics and Director of the Vanderbilt Institute for Global Health, noted the need to address any co-infections that might increase HIV viral load. He pointed to studies linking higher viral load with a higher likelihood of transmitting HIV, and a low load with reduced disease progression and HIV transmission risk. He said a review of a wide number of studies revealed that treating a variety of co-infections, including TB, malaria, schistosomiasis, filariasis, herpes, gonorrhea and syphilis decreased viral load to varying degrees.