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Haiti drug trial is found to slow AIDS

Treatment works as well as in US, researchers say

AIDS sufferers in Haiti, the poorest nation in the Western Hemisphere, benefit just as much from potent drug cocktails as patients in the United States, researchers reported today. The finding has implications for controlling an epidemic infecting 40.3 million people across the globe.

A team of Haitian doctors and nurses working in the slums of Port-au-Prince amid floods, political coups, and economic embargoes, found that a year after 1,000 AIDS patients began taking the pills, 87 percent of adults and almost all the children were still alive. Without medication, barely one-third of the patients are expected to survive a year.

The report, prepared with doctors from Weill Medical College of Cornell University, provides the most powerful evidence so far that campaigns to provide medications to AIDS patients in Africa and the Caribbean can reverse the tide of deaths, specialists said.

The experience in Haiti, detailed in today's New England Journal of Medicine, also appears destined to amplify the clamor for less expensive generic medicines in the developing world. About 90 percent of the medications given to the Haitian patients were generic equivalents, a finding that physicians said should dissolve any lingering resistance by the US government to purchasing generics as part of its global AIDS strategy.

The Bush administration had resisted purchasing generic AIDS drugs, rejecting pleas that overseas authorities had validated their safety. But lately, the US government began buying generics for use abroad after the Food and Drug Administration assured their safety and effectiveness.

Powerful, three-drug AIDS treatments have been a standard feature in the medicine cabinets of US patients for a decade, spawning a steep decline in deaths. But health authorities had long wondered whether the pills would achieve similar results in the poorest corners of the world: Would patients in developing nations take the medicine? Would poverty negate their beneficial effects?

''We know we have a worldwide catastrophe on our hands, and there have been proposed reasons for why therapy wouldn't work as well in developing countries," said Dr. Calvin Cohen, research director for Community Research Initiative of New England, which does AIDS drug trials. ''What this report confirms is that the hesitation to treat is not warranted for any medical reasons."

The Caribbean has disproportionately borne the burden of HIV, with 300,000 people now infected. No country in that region has been devastated more than Haiti.

For more than two decades, a band of Haitian healthcare workers collaborating with Cornell doctors treated AIDS patients, with few advanced medicines

That began to change in recent years as money for treatment began arriving from global sources.

The report released today, believed to be the most extensive published account of AIDS drug treatment in the developing world, chronicles the care of patients starting in March 2003.

Their life circumstances were dire: Dr. Daniel Fitzgerald, senior author of the report, said patients dwelled in cramped, tin-roofed shanties, many without running water or sewage service.

''When they first came into the clinic," said Fitzgerald, a Cornell specialist, ''they were so sick and scared and thinking they were going to die."

The patients got medications, but they also received counseling, food, and vitamins. And they received care for other diseases, including tuberculosis.

The extent of services provided to the Port-au-Prince patients demonstrates the scope of resources needed, said Dr. Ken Mayer, a Boston AIDS specialist involved in treatment in India.

''This shows what is feasible in a very difficult environment," said Mayer, medical research director at Fenway Community Health.

. ''But," he added, ''it's not something you just add water and shake." Crucially, Mayer and other specialists said, the treatment documented in the report was provided by other Haitians. That is a model used most famously by Partners in Health, the Boston nonprofit group that works with doctors in rural Haiti.

''It has to be owned by the local community," said Dr. Mark Dybul, chief medical officer for the US global AIDS campaign. ''The communities are saying, 'We may not be able to do something about the floods, we may not be able to do something about the political situation, but we can do something about AIDS.' "

The researchers tracked the health of 100 patients in detail. Tests showed that as levels of the AIDS virus in their blood dropped, their army of disease-fighting cells added new battalions. Those findings, researchers said, show that the patients were assiduous in taking their medications.

''There still is this sense that poor people don't have the organizational skills in their lives to follow complicated therapy," said Dr. Joia Mukherjee, medical director for Partners in Health. ''This shows that, in fact, that's a prejudice that's just not true."

Stephen Smith can be reached at stsmith@globe.com.

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