CLINICAL RESEARCH, PROPHYLAXIS, THERAPY, AND CARE FOR HIV DISEASE IN AFRICA

By the end of the century, citizens of resource-poor countries will co nstitute 90% of the world's human immunodeficiency virus (HIV)-infecte d people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiolog y, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that ca re for AIDS be addressed, and prevention and care should be seen as in terrelated. Prevention and treatment of tuberculosis, the commonest se vere infection in persons with AIDS in Africa, illustrate this interre lationship. We outline priorities for applied research on the manageme nt of HIV disease in a resource-poor environment, and discuss prophyla xis, therapy for opportunistic diseases, terminal care, and use of ant iretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a source-poor environ ment. Research and public health progams for AIDs in developing countr ies must address AIDS care and attempt to reduce the widening gap betw een interventions available for HIV-infected persons in different part s of the world.