I just came from the morning session of the first ever TB and HIV Symposium hosted at the University of Namibia’s Medical School. At first I was a little confused by all the alliteration in the names of the partners, I heard the Minister of Health and the Permanent Secretary give thanks to the professors Lange, van Lunzen and Addo from Universities in German and ‘Bostan’ and Harvard, which I mistook to mean that Harvard University had somehow been transplanted to Germany. But it turns out Professor Addo, who spoke about the prevention of HIV transmission, had just left Harvard University Medical School in Boston to take up a position in a University in Germany, which I believe is the Research Center Borstel, though it could be Hamburg University. In any case, these international speakers come from reputable places.
Professor van Lunzen took us through several sign posts of the history of HIV-1 disease in the world. Interesting statistics to note are that there are roughly 34.2 million people living with HIV today, of which 9.7 million are receiving Highly Active Antiretroviral Therapy (HAART). This therapy is a huge breakthrough with respect to the early years of the epidemic in 1980s, because now there is not only a treatment that prolongs life for people living with HIV, but there is a global commitment to give it to people who need it. Should then not all 34.2 million people be receiving HAART would give them a chance at a decent life? No, because according to the current World Health Organization guidelines, only 25.6 million of the total are eligible. And yet the global target by the year 2015 is still way below that number at 15 million people on treatment. As it stands now, I learnt, there are 9.7 million on treatment. Clearly there are only two years left to 2015 and therefore an additional 2.5 million people who need HIV treatment must receive it, if we are to meet the target of 15 by 2015.
Professor Lange took us through a history of TB detection and treatment. He illustrated how the number of TB cases in the developed world fell rapidly during the twentieth century, which he attributes to improvements in living conditions. He made the case that improvement in social economic conditions of communities is the single best way to prevent TB. He also explained how difficult it is for patients to complete TB treatment – the standard treatment is 6 months, but this increases to 24 months for extremely drug resistant TB: A patient needs to take this medication every day for two years, a tall order especially if the patient is HIV positive and already has to take antiretroviral medications.
The meeting also had its moments of activism. A local physician,Dr Mugala, asked a question in which she emphasized what a big problem TB is among HIV patients in Namibia and she therefore appealed for a removal of all treatment thresholds for antiretorival therapy (the current one is set at a CD4 count of 500 for asymptomatic individuals) in favor of immediate highly active anti-retroviral therapy for all HIV patients, given the demonstrated efficacy of this therapy in preventing TB.
I really enjoyed attending this conference and I hope to have given you a taste of what it was like. If you have any comments, please post them below.