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th Trading n Currency ll other combinations containing artemisinin derivatives and is not covered by any patent. This development, funded in part by the EU Research budget, illustrates the potential of R&D into other neglected diseases.
HIV/AIDS
An estimated 39.4 million people are living with the HIV virus. Last year AIDS killed 3.1 million people, the majority in sub-Saharan Africa. Only 700,000 of the nearly 6 million people in need of antiretroviral (ARV) treatment against HIV in developing countries have access to it, and since July 2004 only 260,000 new patients have benefited from ARV therapy in developing countries. ARV prices are high and second-line medicines up to twelve times more expensive than the most affordable WHO-recommended first-line generics.
It is estimated that 16 million children under 15 have already lost either one or both parents to HIV/AIDS, leaving the old and young to support each other in families. The needs of children and older people (often carers) should not be neglected.
A massive effort on all fronts of prevention, treatment, care (including palliative care), microbicides and vaccines is needed to achieve a response on a scale that matches that of the global AIDS epidemic.
TB
An estimated 1.8 million people died of TB in 2002. Southeast Asia accounts for a third of cases globally and Africa accounts for more than a quarter.
TB accounts for about 13% of AIDS deaths worldwide. Drug resistant TB is increasing and strains of TB resistant to all major anti-TB drugs have emerged. Particularly dangerous is MultiDrug-Resistant TB. While drug-resistant TB is generally treatable, it requires up to two years of expensive chemotherapy.
Leishmaniasis
The group of diseases caused by Leishmania parasites are transmitted by sandfly bites. The leishmaniases are endemic in 88 countries and 12 million people are affected. Around 1.5 to 2 million new cases occur annually, and this is rising.
The most life-threatening form is Visceral Leishmaniasis (VL), commonly known as kala-azar, which attacks the immune system and from which the 57,000 deaths reported in 1999 is thought to be significantly below the real number. Pentavalent antimony, the most widely prescribed drug to treat Leishmaniasis, was discovered a century ago, has serious side effects, requires prolonged treatment and is losing efficacy in some regions due to parasite resistance. Although newer treatments exist, they are not optimal due to problems of toxicity, high price or difficulty in administration. Co-infection with HIV poses an additional challenge.
AIDS and VL reinforce one another. VL accelerates the onset of AIDS and shortens the life expectancy of HIV-infected people, whilst HIV spurs the spread of VL. AIDS increases the risk of VL by 100-1000 times in endemic areas. Leishmania/HIV co-infections are considered a real threat, even in south-western Europe.
Schistosomiasis
Schistosomiasis (bilharzia) infects 200 million people globally of which 20 million are thought to suffer severe consequences causing about 20,000 deaths annually. Treatment with praziquantel is available but there is concern over the potential for the emergence of resistant parasites. Again there is a need to develop alternative therapies.
Sleeping Sickness
Human African Trypanosomiasis (HAT), or sleeping sickness, is caused by a species of Trypanosoma via the bite of the tsetse fly. The disease ultimately spreads to the central nervous system when the characteristic signs of sleeping sickness appear. HAT is endemic in sub-Saharan Africa with 60 million people at risk. WHO estimates over 300,000 cases of the disease, but most go unreported.
The limited choice of available drugs, their toxicity (causing mortality in 5% of patients), and the disease’s growing unresponsiveness to drugs, make it imperative that new treatments are urgently developed.
Chagas Disease
American Trypanosomiasis or Chagas Disease is prevalent in Central and South America where 18 million people are infected with the parasite and an estimated 50,000 deaths occur annually. This amounts to about 25% of the region’s population at risk, yet only two drugs, nifurtimox and benznidazole - neither ideal - can treat the acute phase; for chronic Chagas Disease there is no treatment at all.
Dengue
Dengue is a mosquito-borne infection found in tropical and sub-tropical regions, predominantly in urban and semi-urban areas. The global prevalence of Dengue has grown dramatically in recent decades and it is now endemic in more than 100 countries.
Some 2,500 million people - two fifths of the world’s population - are now at risk from dengue. WHO currently estimates 50 million cases of infection worldwide every year. Between 1995 and 2001 the number of reported cases more than doubled in the Americas.
In recent years, Aedes Albopictus, a secondary Dengue vector in Asia, has spread to parts of Europe, the USA and other countries thought to be a result of the international trade in used tyres.
There is no specific treatment for dengue fever. Vaccine development for Dengue and Dengue Haemorrhagic Fever is difficult but progress is being made.
Ebola Haemorrhagic Fever
Ebola Haemorrhagic Fever has killed over 1,200 since the Ebola virus was discovered. No specific treatment or vaccine is yet available. Several vaccine candidates are being tested but it could be several years before any are available. A new drug therapy has shown early promise in laboratory studies and is being evaluated further. However, this too will take several years.
Lymphatic Filariasis
Over 120 million people are infected by Lymphatic Filariasis, known as Elephantiasis; over 40 million of them are seriously incapacitated and disfigured by the disease which spreads because of rapid urban growth. Lymphatic Filariasis can cause enlargement of limbs, genitalia and breasts and internal damage to the kidneys and lymphatic system. In endemic communities up to 50% of men and 10% of women can be affected. Treatment is by a once-yearly administration of single doses of albendazole plus either diethylcarbamazine or ivermectin carried out for 4-6 years.
Buruli Ulcer
Buruli Ulcer is an emerging health threat; the third most common mycobacterial infection in healthy people after TB and leprosy. It destroys skin and tissues and causes deformities. Lesions occur mainly in the limbs. At present, the only treatment available is surgery to remove the lesion and a skin graft if necessary. This is both costly and dangerous, with loss of tissues or permanent disability.
Neuropsychiatric Disorders
Mental illnesses are common to all countries and are rapidly increasing. They cause considerable economic and social costs. One in four of us develop one or more such disorders at some stage in life and 450 million people world-wide are affected by mental, neurological or behavioural problems.
Cost-effective treatments exist for most disorders, but mental health legislation, treatment and community care are not given the priority they deserve.
Some 121 million people currently live with depression. Each year 5.8% of men and 9.5% of women will experience a depressive episode and 873,000 people commit suicide each year.
50 million people are affected by Epilepsy; more than 80% of them in the developing world. 70% of people with Epilepsy can be seizure-free if treated with antiepileptic drugs. Although in most countries the cost of treatment can be as low as $5 per patient per year, the vast majority remain untreated. In Africa, 80% receive no treatment.
24 million people have Schizophrenia; 37 million people live with dementia, mainly Alzheimer’s. With ageing populations, this is projected to rise rapidly in coming years.
Child and adolescent disorders are common. 10-20% of children have mental or behavioural problems. The overall prevalence of learning disability is between 1% and 3%. It is more common in developing countries because of higher incidence of injuries and deprivation of oxygen at birth and early childhood brain infections.
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