Tuesday the Trump administration issued a derogation for medicines and medical services life -saving, offering a recovery for an HIV treatment program all over the world that was stopped last week.
The renunciation, announced by the Secretary of State Marco Rubio, seemed to allow the distribution of drugs for HIV, but if the renunciation extended to preventive drugs or other services offered by the program, the emergency plan of the president for the rescue of the AIDS , was not immediately clear.
However, Pepfar’s future remains in danger, with potential consequences for over 20 million people – including 500,000 children – who could lose access to life -saving drugs. Without care, millions of people with HIV in low -income countries would be at risk of full -blown aids and premature death.
“We can return very quickly to where the pandemic is exploding, as if it were in the 80s,” said dr. Steve Deeks, HIV expert at the University of California, San Francisco.
“This cannot really happen,” he said.
On Monday, the Trump administration ordered health organizations in other countries to immediately stop the distribution of drugs for HIV purchased with US aid. The directive derived from a freezing – which could become permanent – in Pepfar’s activities, a program of $ 7.5 billion supervised by the State Department.
Since it started in 2003, it is estimated that Pepfar has saved over 25 million lives; More than 5.5 million children were born free from the HIV which would otherwise have been infected.
Only in South Africa, the arrest of Pepfar would add more than half a million new HIV infections and over 600,000 deaths related in the next decade, according to an estimate.
The organization takes 270,000 doctors, nurses, pharmacists and other health workers. They had been told not to report to work or to serve patients.
The end of Pepfar “would create instability and potentially collapses the AIDS programs from different countries that will be difficult to repair, if and when Pepfar funding return available again,” said dr. Salim Abdool Karim, an epidemiologist for infectious diseases at the University of Kwazulu-Natal in Durban in Durban, South Africa.
Dr. Abdool Karim said that countries should stop relying on Pepfar and supporting their citizens, a goal to which the staff and partners of the program had worked. But ideally that turn would occur gradually, during which Pepfar would have trained local health workers and would prepare them for the transition, he said.
“This is not a bad opportunity for countries to take on greater responsibilities,” he said. “But I think they can’t do it if it is done in this type of random and unplanted way.”
Here’s what he expects from him and others from the unexpected pause of Pepfar.
Sudden stops to the treatment of HIV can quickly become dangerous.
Every day, more than 220,000 people collect HIV drugs in clinics financed by Pepfar; The number included over 7,400 children under the age of 15, according to the data published Tuesday by Amfar, the Foundation for research on AIDS.
The drugs work by suppressing the HIV in the body. When patients come out of drugs, the virus affects the opportunity to bounce – and quickly. Within a week, the HIV levels will rise to the stars from levels not detectable to over 100,000 copies per milliliter of blood.
“It could be a time when you are very at risk of transmitting the virus to others,” said dr. Sallie Permar, Pediatrician and HIV expert at Weill Cornell Medicine.
Therefore, the virus will begin to attack a certain type of immune cell, paralyzing the body’s ability to reject other infections, including tuberculosis, which often accompanies HIV infection.
The stiletto HIV levels can initially cause flores symptoms, including sore throat, swollen glands and fatigue. The immune system will probably bring the strength enough to temporarily suppress the virus, but HIV is skilled in hiding until it finds the right opportunity to re -emerge.
When it presents that occasion, “they can develop AIDS and progress,” said dr. Deeks.
Children can be among the most affected.
Pepfar is known above all for the financing of HIV treatment programs, but its funds also go to drugs for prevention, awareness and tests and to support orphans and women who experience gender -based violence.
The loss of resources for each of these efforts will make the fight against AIDS derail, said Dr. Glenda Gray, a pediatric HIV expert at Wits University in South Africa.
“If the HIV test falls on the roadside, it is unlikely that we will be able to diagnose people who need to go to care,” he said.
If a pregnant or stirring woman has H.IV. But it is not tested and not treated, the virus can pass to her son. The greater its viral load, the more likely it is that this happens.
Children with HIV are less likely to be diagnosed than adults and cannot be treated until the virus makes them visibly very sick. This progression can be much faster in children than in adults, dr. Gray said: “And of course, it is likely that not treated children will die”.
The inconsistent treatment guides drug resistance.
As people lose access to drugs, they can try to distribute their supplies by alternating days or sharing their pills with others. If the virus replies in people with partial protection only, it can learn to evade those defenses and become drug resistant.
People who live with the virus can therefore transmit the resistant virus to others.
“This becomes a big problem, because now, suddenly, our cheap first -line drugs may not work when we have to get them back in treatments,” said dr. Abdool Karim.
A treatment resistant virus will also be better in budding candidates for vaccines to be tested.
“Not only are we watching more drug resistance, but we are trying to lose any ability that we had to make an effective vaccine,” said dr. Excuse.
The end of Pepfar can also hit Americans.
More than a million Americans live with the virus and more than 30,000 are infected every year. If HIV becomes available to available drugs, it is not likely to remain in low -income countries. Americans will also be at risk.
They can also deal with indirect damage from the end of the pepfar. Creating enormous populations of immunocompromese people can mean that other pathogens have the opportunity to spread. For example, it is believed that dangerous Covidi variants, including murderous, have evolved into immunocompromised people with HIV
At the same time, people all over the world benefited from the tests conducted under the auspices of Pepfar, showing the importance of treating HIV early, showing that pregnant women can breastfeed as long as they are treated and that infections From HIV they can be prevented with long action drugs.
“America has obtained an extraordinary amount of love all over the world because of what has been done,” said dr. Deeks.
“From a humanitarian point of view, I can’t imagine that nobody really wants to follow this path,” he added. “This has no sense at any level.”