Several recent headlines have touted massive expansions of HIV testing and antiretroviral treatment as effective means to prevent disease transmission.
Dr. Brian Williams suggested in the (Guardian) that blanket testing and massive expansion of ARV treatment (on the BBC) should be considered for prevention. A vaccine is still a long way off, Williams said, but ARVs now are available and can reduce someone’s viral load by so much they “they become close to non-infectious.”
Dr. Williams hails from South Africa, where nearly one in five adults is infected with HIV. That’s a much different scenario from the HIV epidemic in the United States, and most countries outside sub-Saharan Africa, where HIV tends to be concentrated in high-risk groups. UNAIDS estimates only one-third of South Africans needing ARV treatment currently receive it. At this point, it’s difficult to imagine expanding treatment to people at earlier disease stages.
According to the Guardian, major trials of testing of the blanket testing strategy “are planned in Africa and the US and will feed into a final decision on whether to adopt the measure as public health policy in the next two years.”
At the Conference on Retroviruses and Opportunistic Infections (CROI 2010) in San Francisco this spring Dr. Deborah Donnell of the Fred Hutchinson Cancer Research Center in Seattle, reported findings form a trial in which her team followed 3,400 discordant couples in seven African countries: Only one transmission event was found within a partnership where the infected person was on ART, while 102 HIV infections occurred within partnerships with no ART. "There was a 92 percent reduced risk of infection for the discordant partnerships where the partner was on ART.”
Researchers say more data is needed to see if the benefits would sustain over the long term. These proposals have major cost and resistance implications. Within the GHDonline Adherence & Retention community, many of these issues are discussed, but they are also relevant for this community to discuss.
What do you think of expanding treatment for prevention? What additional evidence to we need? What are some sustainability questions we should be asking?