Book Review A Decade of HAART: The Development and Global Impact of Highly Active Antiretroviral Therapy Edited by José M. Zuninga , Alan Whiteside , Amin Ghaziani , and John G. Bartlett New York: Oxford University Press, 2008. 464 pp $130 (hardcover).
Year: 2010
Type: book-review
Abstract: A Decade of HAART: The Development and Global Impact of Highly Active Antiretroviral Therapy builds on a conference with a similar title that the International Association of Physicians in AIDS Care organized in 2006. The objective of the book is to dquo;memorialize what has become one of the most dramatic successes of medical care in the past 50 years. dquo; The editors comprise a clinician, a sociologist, an economist, and a public health specialist, and the list of authors is truly impressive: 74 authors from 20 countries contributed to the 29 chapters. The book is organized in 3 sections. The first part gives a historical overview from the discovery of human immunodeficiency virus (HIV) to recent developments in therapy for both high-income and low-income countries. The second part describes the epidemiology of HIV infection and the introduction of highly active antiretroviral therapy (HAART) in selected countries, as well as the design and findings from 8 HIV cohort studies. The third part discusses the challenges in the next decade of HAART, including the gap in HIV care and access to HAART between high-income and low-income countries. The foreword by Luc Montagnier and Robert Gallo is one highlight: it gives a lively and concise account from the discovery of HIV to the introduction of HAART and its failure to eradicate HIV. Montagnier and Gallo argue that the profound immunodeficiency associated with HIV infection and the incomplete immune recovery achieved by HAART explain why the virus persists. They end on an optimistic note: in future decades, additional treatments aimed at boosting the immune response might achieve long-term suppression without HAART. Despite some overlap, the first and the last sections of the book include many excellent chapters, which are well referenced. The chapter by Roger Paredes, Renslow Sherer, and Bonaventura Clotet titled dquo;The clinical challenges of lifetime HAART dquo; is particularly comprehensive, citing 322 references. Zuniga and Ghaziani, in their chapter on dquo;A world ravaged by a disease without HAART, dquo; give a gripping account of the early years, the dquo;Dark Ages dquo; of HIV/AIDS treatment, and the response of civil society and the health professions. In their chapter titled dquo;Redefining HIV/AIDS care delivery in the face of human resource scarcity, dquo; Mario Roberto Dal Poz, Norbert Dreesch, and Dingie van Rensburg argue for a paradigm shift in allocating care and human resources: all other health programs will suffer if no integrated solution is found. One noteworthy omission is a chapter that addresses treatment as prevention and more generally that addresses the place of HAART and HAART programs in preventing the spread of HIV. The middle section, which fills 20 of the 29 chapters, is the weakest part of this book. One wonders here whether less might have been more: this is a convenience sample of country profiles and descriptions of cohort studies, with little evidence of editorial and conceptual guidance. The chapters are heterogeneous in their approach, and some are fairly superficial. Some are more interesting than others; for example, the account from China provides a wealth of information on the scale-up (or lack thereof) of the National Free Antiretroviral Treatment Program. Zhang Fu-Jie, Ray Y. Chen, Selina N. Lo, and Ma Ye report that only 20% of the estimated 650,000 people with HIV living in China in 2006 had been identified, and of those identified, im;20% had started HAART. This number has now almost doubled, according to a recent journal article by some of the same authors [1]. Surprisingly, the median CD4 cell count at the start of HAART decreased from 159 cells/ µL to 118 cells/ µL. We observed opposite trends during scale-up of HAART in sub-Saharan Africa [2]. In summary, this book provides a fascinating and accessible account of the first decade of HAART and of 25 years of HIV infection that will be of interest to many. Much remains to be done, however, before the final account of this intriguing story can be written.
Source: Clinical Infectious Diseases
DOI: 10.1086/650736
Authors: Olivia Keiser, Matthias Egger
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1900187074