Meet the Expert

David Cooper, Director, National Centre for HIV Epidemiology and Clinical Research, Australia

Dr Cooper presented the ideological scenario that should be the gold standard of treatment and care for all nations. The paradigm is to drive viral load to the limit of detection. Mono and dual therapy produce only transient responses, resulting in sub-optimal viral inhibition and creating an environment, which encourages viral resistance development. Therefore triple therapy has to be the gold standard for all. However, there are powerful arguments for dual and even mono therapy in resource-poor settings. Dual therapy, though not optimal, results in a 60 percent decrease in mortality and is a fifth of the cost of triple therapy, but pricing changes may negate this difference. Because of late presentation and diagnosis, many cases are terminal and any intervention which improves quality of life and extends life, if only slightly, is beneficial. HIV transmission and drug resistance are not issues with these people. Dual therapy is widely used in India, Thailand and Malaysia. Doctors have a duty of care for their patients and where triple therapy is unaffordable dual therapy, when used wisely, is better than nothing. An economic disadvantage of dual therapy is that it may send the wrong message to governments.