The importance of early detection in the fight against HIV/AIDs has been emphasised again on the eve of World AIDS day, December 1.

Early detection is vital for early treatment and increasing life expectancy, as estimates show that about one third of people infected with HIV in Europe are unaware they have it, the European Commission said in a statement.

To fight AIDS on a global scale, EU Commissioner for Development Andris Piebalgs recently announced a 10 per cent increase in contributions to the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), to which the EU is already the largest donor, providing 52 per cent of resources.

The increase would allow the European Commission to contribute about 1.3 billion euro over the period 2002-2013.

On the eve of the annual World Aids Day, John Dalli, European Commissioner for Health and Consumer Policy said: "HIV and AIDS have been causing great suffering to people and communities across the world for more than a quarter of century. Testing is an important first step to fight the virus. Today is the time to build up momentum; and strengthen our commitment to fight this terrible disease."

Andris Piebalgs, Commissioner for Development added: "Without a healthy population it is impossible to create inclusive and sustainable growth in developing countries to reach the Millennium Development Goals. AIDS remains one of the most deadly diseases and we have to increase our efforts in preventing the spread of this virus."

Despite the overall decrease in the number of new infections, the total number of people living with HIV worldwide continues to grow.
 
The number of people living with HIV globally now stands at 33.4 million. Sub-Saharan Africa remains the worst affected region, accounting for 71% of all new HIV infections in 2008.

As the world's biggest donor of development aid, the European Commission remains committed to its engagement in fighting AIDS in cooperation with its partner countries all over the world, the Commission said.

The UN News Service said that global efforts to halt and even reverse the spread of HIV/AIDS are showing welcome results, with the number of people newly infected declining and AIDS-related deaths falling, according to the latest report from the United Nations agency leading the fight against the disease.

The Report on the Global AIDS Epidemic 2010, produced by the Joint UN Programme on HIV/AIDS (UNAIDS), contains basic HIV data from 182 countries and includes country-by-country scorecards. It shows that an estimated 2.6 million people became newly infected with HIV, nearly 20 per cent fewer than the 3.1 million people infected in 1999. In 2009, 1.8 million people died from AIDS-related illnesses, nearly one-fifth lower than the 2.1 million people who died in 2004.

UNAIDS said that together, this is contributing to the stabilization of the total number of people living with HIV in the world, although much more still needed to be done, especially in light of reduced funding for the global response to AIDS.

"We are breaking the trajectory of the AIDS epidemic with bold actions and smart choices," said the Executive Director of UNAIDS, Michel Sidibé. "Investments in the AIDS response are paying off, but gains are fragile – the challenge now is how we can all work to accelerate progress."

According to the report, from 2001 to 2009, the rate of new HIV infections stabilised or decreased by more than 25 per cent in at least 56 countries around the world, including 34 countries in sub-Saharan Africa.

Of the five countries with the largest epidemics in the region, four countries – Ethiopia, South Africa, Zambia and Zimbabwe – have reduced rates of new HIV infections by more than 25 per cent, while Nigeria’s epidemic has stabilised.

Sub-Saharan Africa continues to be the region most affected by the epidemic with 69 per cent of all new HIV infections. In seven countries, mostly in Eastern Europe and Central Asia, new HIV infection rates have increased by 25 per cent. Among young people in 15 of the most severely affected countries, the rate of new HIV infections has fallen by more than 25 per cent, led by young people adopting safer sexual practices.

Condom use and availability have increased significantly.

Eleven countries – including Burkina Faso, India and Peru – report more than 75 per cent condom use at last higher-risk sex.

Data from 78 countries show that condom use among men who have sex with men was more than 50 per cent in 54 countries. Reports of condom use by sex workers are also encouraging – in 69 countries, more than 60 per cent of sex workers used a condom with their last client.

Access to HIV prevention services, including harm reduction programmes for people who inject drugs, has reached 32 per cent – far short of what is needed to protect drug users from HIV worldwide, the report noted. Even though many countries have included male circumcision in their prevention programmes, uptake at a population level remains low, and has not made a significant impact on the rate of new HIV infections.

However, UNAIDS noted in its report that even though the number of new HIV infections is decreasing, there are two new HIV infections for every one person starting HIV treatment.

Investments in HIV prevention programmes as whole have not been adequate or efficiently allocated. HIV prevention investments comprise about 22 per cent of all AIDS-related spending in low- and middle-income countries.

In relation to the report’s findings that more people are living longer and AIDS-related deaths are declining as access to treatment has expanded, UNAIDS said that the total number of people on treatment increased by seven and half times over the past five years with 5.2 million people accessing life-saving drugs in 2009, compared to 700 000 in 2004.

Over the course of the past year alone, an additional 1.2 million people received treatment – a 30 per cent increase compared to 2008. In addition, there has been a secondary dividend of stopping new HIV infections with increased access to HIV treatment. But nearly twice the number of people – 10 million – are waiting for treatment. New evidence shows that scaling up treatment has led to reductions in population mortality in high-prevalence settings.

As more countries are using effective treatment regimens to prevent HIV transmission to babies, the total number of children born with HIV has decreased. An estimated 370 000 children were newly infected with HIV in 2009, representing a drop of 24 per cent from five years earlier.

The report also contains new data which shows that human rights efforts are increasingly being integrated into national AIDS strategies, with 89 per cent of countries explicitly acknowledging or addressing human rights in their AIDS strategies and 91 per cent having programmes in place to reduce stigma and discrimination. However, punitive laws continue to hamper access to AIDS-related services – 79 countries worldwide criminalise same sex relations and six apply the death penalty.

UNAIDS estimates that a total of $15.9 billion was available for the AIDS response in 2009, $10 billion short of what is needed in 2010, and that funding from international sources appears to be falling. Donor governments’ disbursements for the AIDS response in 2009 stood at $7.6 billion, lower than the $7.7 billion available in 2008.

The agency said that the declines in international investments will affect low-income countries the most – nearly 90 per cent rely on international funding for their AIDS programmes – and that there is an urgent need to sustain and scale up good investments and for countries to share the financial burden of the epidemic.

The Voice of America reported that a new study says that delaying treatment for people infected with HIV can have long-term health and financial consequences.  The findings add to the debate over when anti-retroviral treatment should begin.
 
A growing body of research says starting HIV-infected people on drug treatment sooner is better for the patient.  Initially, the drugs were given when a person’s CD4 immune cell count fell to 200 or below.  By that time, the patent could have full-blown AIDS.
 
Now the general recommendation is to start treatment when CD4 counts reach 350 – before the immune system collapses.  Despite that recommendation, many people are receiving delayed treatment.
 
Dr. Kelly Gebo – a Johns Hopkins University professor of Epidemiology – is the senior author of the study.  Gebo and her team reviewed the medical records of more than 8000 patients in the United States between 2000 and 2007.
 
"So, we actually didn’t look at when to start treatment.  We looked at when people presented for care.  And we found that unfortunately nearly half of people – 43 per cent of people – were presenting late for care.  And those people cost more over the long run," she says.
 
Gebo says the study did not look at why treatment was delayed, but the findings did give a few hints.
 
"One of the things anecdotally that we do tend to find," she says, "is that people are hospitalized for a severe opportunistic illness and then sort of follow-up for outpatient care.  They may have known they were HIV infected for a long period of time and not come for care just because they didn’t feel bad or everything was going well.  And then when something catastrophic happens is when they start embarking on care."
 
Once a person is infected with HIV, unless treatment is given, there’s usually a long but steady decline in CD4 cells. 
 
So, symptoms of the disease may not appear right away.
 
Gebo says, "Most people have a CD4 count between 800 and 1200.  So we say an average of a thousand.  And in HIV when we didn’t have antiretrovirals the average CD4 count fell by about a hundred cells per year.  So we said it was about eight years from infection to development of AIDS.  And in general, it was about a 10-year life expectancy.  Now, with antiretrovirals, the whole ballgame has changed."
 
Earlier treatment with antiretrovirals gives a person a much better chance of avoiding other illnesses besides full-blown AIDS.
 
"So clinically we know that people do better," she says, "They have fewer opportunistic illnesses.  They seem to have fewer non-traditionally AIDS-related events.  So, cardiovascular disease, malignancies, end stage liver disease, end stage renal disease – all appear to be higher in HIV-infected patients.  So treatment with antiretrovirals has been shown to slow the progression of some of those."
 
And then there are the medical costs.
 
The average difference - between those receiving treatment early and those who didn’t - ranged from about $27 000 to more than $60 000 over the first seven to eight years.  Costs are higher for the so-called late presenters because they are often sicker than early presenters.
 
"We did look at direct medical costs.  And in the direct medical costs, it was certainly cheaper with treating people with antiretrovirals, even given the cost of 10 to 12 thousand dollars a year for antiretrovirals when you look at the reduction in hospitalizations, other medications used and some of the other outpatient utilization and laboratories that we evaluate in our study," she says.
 
And earlier treatment allows people to be more productive longer.
While the study was not done in a developing country, the findings may provide guidance.  Some countries in sub-Saharan Africa, for example, are debating whether to start antiretroviral treatment earlier. 
 
However, that means spending more on HIV/AIDS at a time when many economies are still reeling from the global recession.
 
More details on the study can be found in the December issue of the journal Medical Care.