Author's response: expert reviews: who are they for?

To the editor,

According to the latest data published by UNAIDS [1], more than 33 million people are infected with HIV worldwide, of whom 22 million live in Sub-Saharan Africa. Ninety-seven percent of newly diagnosed HIV cases occur in low and middle income countries, where antiretroviral coverage is often insufficient. This drama must remind the entire medical and scientific establishments which and where the main needs are, in terms of HIV treatments, as highlighted in an editorial article in this issue [2].

The development of newer antiretrovirals, such as Rilpivirine (RPV) which has been discussed in a recent issue [3], is always positive for people living with HIV, because important advantages may be obtained from them. Currently, HIV therapy should be regarded as a chronic treatment, requiring lifelong adherence. Thus, the development of antiretrovirals in fixed-dose coformulations is a useful tool in order to increase adherence, a key factor for therapeutic efficacy [4]. Newer antiretrovirals often provide other important advantages, like improved efficacy, more favorable safety profiles or different patterns of resistance mutations, allowing its use in heavily pretreated patients.

All these improvements should be available for all HIV-infected patients worldwide. Nevertheless, reality is very different from this aspiration. An important number of economic, social, cultural, and political factors make this aim difficult to achieve. The whole scientific community, from pharmaceutical companies which develop new drugs to investigators who design clinical trials and care deliverers who, with their daily practice and their clinical research create opinion trends regarding antiretroviral therapy, should increase their focus in limited-resource settings.

Obtaining data regarding specific aspects of new antiretrovirals are not always simple. The enrolment in clinical trials of specific populations, such as pregnant women or children, raises ethic and legal issues which are not easy to solve [5]. On the other hand, data from in vitro studies, especially regarding pharmacokinetic parameters or drug–drug interactions, are increasing with time, providing useful information for treating patients with comorbidities, such as tuberculosis.

Globally, information on new antiretrovirals is becoming available in reasonable places of time, and provides data on more specific and complex aspects. The scientific community has to reflect on whether this information is aimed and provided to care deliverers and patients in developing countries, who have to fight the heavy burden of HIV epidemics.

Declaration of interest

The authors declare no conflict of interest. This work was supported in part by grants from Fundación Investigacion y Educacion en SIDA (IES), Red de Investigacion en SIDA (RIS, FIS-RD06/0006) and the European Union 6th Framework Programme (NEAT, No. LSHP-CT-2006-037570).