Friday, August 15, 2008

Opportunistic Infections in Developing Nations: A World Away

In the United States and other developed nations, for many people, AIDS has become a manageable disease. With adequate care and lots of medication, HIV positive individuals can live with relatively few serious complications for a long time. In the US, 71% of HIV-infected individuals have at least started HAART therapy, decreasing deaths per infected individuals per year from 30/100 to 5/100 since the 1980’s. In developed nations, however, HIV positive individuals do not have the luxury of adequate care. In areas like Africa where the burden of disease is highest, HIV positive individuals must face an array of opportunistic infections as their CD4 counts dip lower and lower.

Because these opportunistic infections are generally localized to areas where HAART is not available, it is both hard for us to understand the difficulties in treatment and to determine which infections are endemic to what populations. For example, MAC (for Mycobacterium avium complex) is a common, life-threatening opportunistic infection in Asia causing a significant portion of AIDS-related mortalities. In Africa, however, MAC is rare. In addition, tuberculosis is a particularly life-threatening coinfection that is particularly common in many developing areas, especially Sub-Saharan Africa and Asia. Many opportunistic infections in these nations have developed resistance to the drugs typically used to treat them. Determining which disease populations have resistance to what medications can be exceptionally difficult given how isolated some of these areas are.

The HIV/IDS prevalence is highest in sub-Saharan Africa

The most reputable source for information like this is undoubtedly the World Health Organization. The WHO publishes information on the geography, morbidity, symptoms and treatment of various opportunistic infections for different nations and settings. While it is hard to determine where exactly the WHO gets their sources for information from developing nations, it is clear that they get their information from all parts of the globe. However, it is also hard to pick apart the complicated interactions of HIV and opportunistic infections in a multitude of settings, and even harder when there are additional complicating factors such as malnutrition, social unrest, and a lack of medical infrastructure for reporting treatment schemes. Many times, the WHO provides useful information about the scope of opportunistic infections in developing nations, but they often miss the deeper and more individual issues that a given region may have. If first-line drugs for opportunistic infections are not available in these developing areas (due to oppressively high costs or restrictive storage conditions), the WHO lacks vital information on how to cope.

The availability of antiretrovirals in lowest in sub-Saharan Africa

While it is not the fault of the WHO that there is a dearth of useable information for medical workers in low-resource environments, it is clear that there is a lack of necessary medical care in these nations that perpetuates a cycle of poverty and illness and that millions of HIV-positive individuals are dying as a result of a lack of ARVs. In a situation where prohibitively high costs of necessary drugs prevents individuals from being treated for HIV, we need to focus more on preventative efforts and HIV prophylaxis in the form of vaccines or microbicides. In this sense, the US and other developed nations are providing a massive amount of resources in trying to find a vaccine and developing useful microbicides to prevent HIV infection from happening in the first place. Because of the massive amount of people infected in areas that lack the resources to treat them, the disease needs to be treated when it is least expensive to do so. While it is hard to know what the future holds for those with HIV in developing nations, it is sure that we need to develop better ways of treating opportunistic infections and preventing the development of AIDS from HIV.

For more information on the global context of the AIDS pandemic, please visit:


Carley said...

I think it is extremely important that we do our best to continue to educate the American people about safe sex and HIV prevention.

One Condoms has started the Presidential COndom Challenge Campaign in order to help our next president address the overwhelming increase of HIV infections per year in America.

The number of HIV infections in America alone has reached over 56,300 per year! In response, One Condoms has delivered 56,300 condoms (one for every person who will be infected with HIV this year) to the campaign headquarters of Senators Barack Obama and John McCain. The message is simple - demonstrate your support for comprehensive health education for all Americans, including the use of condoms.

To check this out further or join the team to help our future president promote safer sex education, visit

Thanks, Carley

David Wessner said...

Thanks for the note, Carley. Yes, 50,000 new infections a year means that the safer sex message isn't being heard. Thanks for letting all of know about One Condoms.


Anonymous said...

Stop with the racist allegations about HIV & Africans already: Aids in African is a profit-driven, manufactured myth!