Reading Response for 10/28

Paying attention to drugs' side-effects is always important, but judging by the implications mentioned in the Kumarasamy paper, attending to side-effects seems particularly important in HIV/AIDS cases. After experiencing adverse reactions to HAART, many patients discontinued, changed, or interrupted their drug regimen. Not only does this harm the patients' health, but it also can allow the HIV virus to develop resistance, which in turn makes effective treatment even more difficult and/or costly. The article referenced increased hepatitis cases for patients taking NVP regimens - what kind of hepatitis is referred to? Is it the viral A/B/C varieties or is it some other kind of liver disease? It is clear that these potent drugs are pretty hard on a person's liver already, so the development of hepatitis in addition must be quite serious. My other question in regard to this article is if there is any significant difference between the generic HAART that was the subject of this study and the "name brand" HAART that is given in developed countries.

Two of the most interesting statements from the Cohen article were "Whatever we come up with, we always find a big exception in Asia" (Peter Piot, head of UNAIDS) and "It would be wise to assume the worst rather than best" (Richard Feachem, epidemiologist with The Global Fund). The first statement speaks very well to the complexity of the HIV/AIDS epidemic, especially as people attempt to apply lessons learned in one region of the world to a completely different cultural context. Perhaps some of the "exceptions" come up because Asia is anything but a simple entity unto itself. Though this statement seems to lump "Asia" into one category, I thought the article did a pretty good job at exploring the cultural and epidemiological nuance within Asia.

I found the second statement by Dr. Feachem interesting because of its implications for policy. Clearly it is a good idea to be prepared for the spread of the epidemic, but I can see that some people would be quick to point out the practical disadvantages of "assuming the worst." Policy makers have to weigh the risk of the HIV/AIDS epidemic against the risk of other public health problems. Limited resources (which are even more limited in the less developed countries in Asia) mean that everything put into HIV/AIDS prevention or treatment programs cannot be used as easily for other public health goals. Ideally, HIV/AIDS measures would contribute to health in other areas as well (i.e. families have access to clinics, people are more aware of sexual health issues, etc), so perhaps the "limited resources" argument is a bit ill-founded. In any case, this statement caused me to wonder if over-preparedness is necessarily a good thing.