Integrating Treatment for AIDS and Other Neglected Tropical Diseases

Thirty years after AIDS was first reported, the United Nations will meet today to discuss next-steps toward controlling the disease. Developing countries in Africa are still the hardest hit by AIDS, but progress is being made through the framework of the Millennium Development Goals, which calls for a reversal of the spread of HIV/AIDS in the developing world by 2015.

The sixth Millennium Development Goal is to “combat HIV/AIDS, malaria and other major diseases,” and while there are numerous programs and billions of dollars directed at the “big three” diseases—HIV/AIDS, malaria and tuberculosis— the “other” diseases, which include neglected tropical diseases (NTDs) such as rabies, leprosy and parasitic infections, still plague the developing world.

In an editorial published June 5th in the New England Journal of Medicine, Jeffrey D. Sachs and colleagues mark the 30th anniversary of the discovery of AIDS with a call to integrate treatment of NTDs with existing programs for HIV/AIDS, malaria and tuberculosis. The result, they propose, would be a decrease in the incidence, severity and fatality of disease across the board in the developing world. The cost is 50 cents per person.

The editorial cites new research suggesting that many of the most common NTDs, though not disabling or fatal alone, make people more susceptible to major disease and reduce their chances for a positive outcome if they are infected with any of the big three. The parasitic infection schistomiasis, for example, can cause genital ulcers that significantly increase HIV transmission. Treatable parasitic worm infections increase the odds that a person will contract tuberculosis. Hookworm and malaria co-infection leads to severe anemia, which can slow a child’s physical and cognitive development.

There is also significant geographic overlap between high rates of NTDs and of HIV/AIDS, tuberculosis and malaria. So including packages of NTD drugs and treatments with those for primary diseases would not require major changes to the infrastructure, activities and protocols of established disease initiatives. The improvement in health outcomes, however, would be dramatic. By Integrating NTD treatment with existing programs, we can efficiently reduce the incidence of NTDs, improving the health of the world’s poor and taking a step toward eradicating preventable disease.

A preview of the full article is available here.