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From 2003 to 2006, the number of human immunodeficiency virus-infected people in sub-Saharan Africa able to access antiretroviral therapy (ART) has increased from 100,000 to >1 million. The World Health Organization estimates that >3.5 million patients are still in need. The challenges to more expeditious provision of ART in Africa are many. This article is an analysis of the barriers to ART scale-up that are unique to South Africa. With 5.3 million people infected and 1 million needing ART, this country carries nearly one-quarter of the treatment burden of the continent. Although South Africa is undeniably a middle-income nation, inequities born of apartheid, lack of political commitment, poverty, and cultural barriers have significantly slowed efforts to provide universal access to ART to South African citizens. [ABSTRACT FROM AUTHOR]

Background. A potential confounding factor in the treatment of human immunodeficiency virus (HIV) infection in Africa is the frequent occurrence of opportunistic infections (OIs). OI-induced immune activation can interfere with HIV-1 clearance by increasing viral replication and target cell availability. Study design. Treatment outcomes for patients dually infected with HIV-1 and Mycobacterium tuberculosis or HIV-1 and human herpesvirus (HHV)-8 were assessed by measuring changes in viral load and CD4+ cell counts and by determining the time taken to reach undetectable HIV-1 RNA levels, assessed by means of Kaplan-Meier survival analysis. Patients with HIV-1 and Kaposi sarcoma (KS) received generic nevirapine, stavudine, and la- mivudine (3TC); patients with HIV-1 and tuberculosis (TB) received standard commercial didanosine, 3TC, and efavirenz. Results. Both cohorts exhibited a rapid, near-exponential phase I decline in viral load. Patients with TB and late-stage KS had the steepest decay kinetics. These same patients had the greatest initial increase in CD4+ cell counts. Phase II clearance was slower and more variable. The proportions of patients reaching undetectable plasma HIV-1 levels at days 7, 14, 28, 60, and 90 were, respectively, 15.8%, 30.0%, 52.6%, 78.9%, and 93.8% (Pearson's = 50.5; P< .001) for patients with TB and 0.0%, 5.0%, 22.2%, 64.7%, and 80.0% (Pearson's x² = 63.6; P<.001) for patients with KS. Conclusions. Nucleoside reverse-transcriptase inhibitor/nonnucleoside reverse -transcriptase inhibitor-based treatment regimens are highly effective in clearing rapidly replicating (phase I) virus in African patients dually infected with HIV-1 and either TB or KS. [ABSTRACT FROM AUTHOR]