From the Director

The Temptation to Sacrifice Quality for Quantity

Annette Sohn, M.D.

July 2011—In the push to scale-up antiretroviral therapy (ART), we cannot forget our commitment to quality—the quality of drugs and drug regimens, patient support, provider education, and laboratory monitoring. At this point in the history of HIV/AIDS, we know a great deal about what works well and what doesn't on many fronts. Yet suboptimal drugs are still being employed and effective prevention strategies remain underutilized. Why are we not phasing out stavudine (d4T) in both adults and children? Why is the Asia-Pacific region behind Africa in coverage of interventions to prevent mother-to-child HIV transmission?

In this issue of the TREAT Asia Report, Dr. Quarraisha Abdool Karim shares her insights into sustainable ways to introduce high quality ART in resource-limited countries—and fills us in on when women might have access to the microbicide she helped test through CAPRISA. We also examine the expansion of treatment through the lens of the new Asia Treatment Working Group, and look at a program that focuses on strategies for delivering pediatric treatment in the face of drug resistance. Finally, we include a research update on lipodystrophy and its association with d4T in the TREAT Asia HIV Observational Database—results that mirror earlier findings in children by pediatric network partners in Thailand.

The past year's advances in HIV research have been "game changers," as UNAIDS' Michel Sidibé has said, showing us that the epidemic could be slowed or even halted if the goal of universal treatment could be realized. Putting people on ART is a critical step, but we need supportive health systems and broader access to antiretroviral medicines to ensure that they can stay on treatment over a lifetime. We cannot sacrifice long-term success to the urgency of short-term treatment numbers. As we set out to reach the United Nations' ambitious new treatment targets to get 15 million HIV-infected people on ART and eliminate mother-to-child transmission by 2015, quality must be a priority.

Annette Sohn, M.D.