EAST LANSING, Mich. — A Michigan State University physician has witnessed firsthand what is a huge dilemma for many health care providers who care for patients in Africa who suffer from both AIDS and epilepsy. 

It was recently discovered that the primary medicine used to treat epilepsy in these developing countries weakens the effect of one of the few agents available to treat AIDS. Worse yet, combining these two treatments can “teach” the AIDS virus to become resistant to an entire class of drugs, called “protease inhibitors,” potentially affecting patients worldwide. 

Gretchen Birbeck, an MSU neurologist and epidemiologist who does clinical and research work in the African nation of Zambia, became aware of this problem as she cared for patients who suffer from both diseases. 

Internationally recognized for her work with epileptic patients, she confirmed her observations with her peers in neighboring countries, and then called for an immediate investigation. The September 2007 issue of The Lancet Neurology addresses her concerns in its lead article. 

Epilepsy, she noted, is about 10 times more common in Africa than in the United States, and is both a life-changing and life-threatening disease if untreated. Social stigma against persons with epilepsy is very high, and they often suffer burns, injuries or drowning during seizures.  

“I am very concerned that in facing this problem, persons will perceive epilepsy as being the less dangerous disease, and simply stop treating it,” Birbeck said. “The truth of the matter is that epilepsy may often be more immediately life-threatening than AIDS for these patients. 

“Health care workers and their patients in developing countries, who need to use drugs that are as inexpensive as possible, face a terrible choice,” she continued. “Do we treat only one of two life-threatening conditions? Or do we risk the health of the patient in front of us to preserve the effectiveness of the AIDS medication for patients of the future?” 

One possible solution, Birbeck noted, is the use of an epilepsy treatment just emerging from patent restriction that might provide an inexpensive choice without compromising AIDS treatment. 

In response to Birbeck’s alert, The Lancet Neurology urges that “HIV and epilepsy researchers must now work together urgently to find an alternative that does not force epilepsy patients with HIV to make a bleak choice.” 

To access The Lancet Neurology, visit the Web at www.sciencedirect.com/science/journal/14744422. 

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