One year after the arrival of full course antiretroviral treatment (ART) in Haiti, GHESKIO published in the New England Journal of Medicine (NEJM) its outcomes on the first 1,000 patients placed on ART in Haiti.  Whereas in the earliest days of the disease 90 percent of patients were dead in one year, after one year of ART, 90 percent of GHESKIO patients were still alive, an outcome equal to that of the most advanced health care systems in the world.   

2009 marks the 5th anniversary of the advent of antiretrovirals to GHESKIO and its achievement of ensuring that outcomes are still at world-class levels.  In September, GHESKIO published in the NEJM its 5 year outcomes demonstrating that due to the team effort of field workers, pharmacists, counselors, nurses, physicians, donors, and staff that 75 percent of HIV positive patients are still alive.  While great strides have been made in mortality rates, GHESKIO seeks to improve further still through a comprehensive approach targeting endemic diseases as well their roots in poverty.  

GHESKIO’s main location in some of Haiti’s largest slums has imbued a unique environmentally-gained perspective into its mission daily.  This viewpoint has enabled it to serve its immediate neighbors’ needs, but also to produce studies that greatly edify international health policy, particularly for the Global South.  The new 2009 World Health Organization guidelines for initiating ART at a higher CD4 count are based very largely on GHESKIO’s performance of the first controlled trial showing clearly that patients who started ART at a CD4 count of <200/mm3 had a four times greater risk of death and twice the incidence of TB than those who started ART at the now recommended CD4 count of <350/mm3.   While the world cannot ever afford to lose lives unnecessarily, prior to GHESKIO’s systematic, comparative study, it was generally accepted that costs resulting in providing ART earlier would outweigh the benefits for patients in low-income countries.  Further, the initial results from a joint Cornell-GHESKIO nutritional study presented at the World Bank on World AIDS Day in December 2009 provide the first demonstrable link between hunger and the progression of HIV disease.  The risk of developing AIDS and/or dying could increase by 36 percent for HIV-infected people with high levels of hunger and poor nutrition as opposed to other infected adults with access to nutritious food. The new study provides the first-ever clinical evidence linking food insecurity to immune dysfunction and lower numbers of CD4 counts, showing the combined impact of poverty and hunger on people living with HIV/AIDS.