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Treatment and prevention measures for human immunodeficiency syndrome (AIDS) vary widely from country to country and region to region. The availability of treatment for human immunodeficiency virus (HIV) infection and AIDS is highly variable and largely dependent on national wealth and medical infrastructure. Prevention programs also differ greatly between countries, and in places where the epidemic has been stemmed, that often has been the result of a number of complex and interrelated factors rather than a single prevention strategy.

In wealthy societies with a strong medical infrastructure and widespread public or private health insurance coverage, treatment of HIV/AIDS often begins shortly after a patient is diagnosed with HIV. In the early stages of the infection, when HIV is present but CD4 counts are high, it is recommended that individuals engage in generally healthy practices: eating well, avoiding exposure to other diseases or infections, and refraining from behaviors, such as smoking, that might weaken the body's immune response. As the CD4 count begins to drop, doctors may begin prophylactic treatment designed to prevent common opportunistic infections. In later stages of the disease antiretroviral (ARV) drug therapy is instituted.

A number of antiretroviral drugs may be used singly or in combination. Single-drug therapy is the least expensive but tends to provoke rapid mutation of the virus. Dual therapy is cheaper than triple therapy but works more slowly and may not be as effective over the long term. Triple therapy is considered a HAART (highly active antiretroviral therapy) regimen, which means that it is capable of reducing the viral load in a significant number of people and remains effective for many years. Triple therapy is able to reduce viral loads quickly to almost undetectable levels. Early HAART treatment reduces the risk of bodily damage during extended periods of high viral load but leaves few options if the patient later develops resistance to the drugs. As a result some doctors choose to begin with single-drug therapy and gradually increase the treatment level.

The cost of antiretroviral drugs is substantial and for many people and nations prohibitive. In wealthier nations AIDS drug therapy can range from $10,000 to $20,000 per patient per year or even more. Political pressure and competition from generics have resulted in substantially lower drug costs in many underdeveloped countries; some ARV triple-drug therapies are available for less than $200 per year. In most instances, however, those prices are still prohibitive for residents of many countries; researchers have estimated that drug costs have to be lowered by at least two-thirds. Moreover, drug therapy requires regular consultations and follow-up visits as well as routine testing of CD4 levels and often tests for drug resistance.

In many developing countries such care is often inaccessible, unavailable, or unaffordable. Poverty tends to make adherence to a drug regimen difficult, and when adherence drops too low, viral resistance develops. ARV drugs provided without adequate funding and support thus may increase mutation and drug resistance in HIV strands. Additionally, patients in poorer regions are far more likely to have secondary infections before ARV treatment begins; treatment for secondary conditions such as tuberculosis and meningitis is often unavailable or unaffordable.

References:

Barnett, Tony, and Alan Whiteside. 2006. Aids in the Twenty-First Century: Disease and Globalization. 2nd edition. New York: Palgrave Macmillan.

Green, Edward C. 2003. Rethinking AIDS Prevention: Learning from Successes in Developing Countries. Westport, CT: Praeger.

Usdin, Shereen. 2003. The No-Nonsense Guide to HIV/AIDS. London: Verso.

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