Call for Treatment as Prevention
posted: 10/03/2009
Pioneers in HIV research now call for testing of a strategy that uses treatment-as-prevention deserves testing out.
One of the pioneers of HIV research, former Harvard retrovirology professor William Haseltine, said today that universal testing and treatment now offers the best hope of controlling the HIV pandemic.
Writing in the news magazine The Atlantic, Haseltine said that three other authorities involved in the discovery of HIV – Robert Gallo, Max Essex and Robert Redfield – have reached the same conclusion.
“History has shown that epidemics can be controlled, even in the absence of a vaccine,” he says. “Both syphilis and tuberculosis were pandemic at the end of the nineteenth century, and both epidemics were controlled by effective diagnosis and treatment.”
Global call for new treatment-as-prevention strategy
“I recommend that WHO, PEPFAR and the Global Fund begin studies to assess the effectiveness of universal testing and early treatment for the prevention of HIV transmission,” he urges.
Vaccines doubts
At a recent seminar on global governance challenges at the James Martin 21st Century School at Oxford University, Professor Jonathan Weber of London’s Imperial College said that after 27 years in HIV research, he no longer believes a vaccine to be achievable. Instead he believes that population-based antiretroviral therapy (PopART) is the only strategy currently available that holds out the prospect of HIV eradication.
WHO - S Africa and UK
Population-based treatment, or maximising the numbers testing and on treatment, is a subject of growing interest to researchers. Last November the World Health Organization published details of a mathematical modelling exercise which suggested that if all people in South Africa could be diagnosed and begin antiretroviral treatment within a year of infection, the number of new infections could be reduced by 95% within ten years. It also looked at its use in the UK.
Montreal conference calls
Then at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal, Canada earlier this month, two studies of transmission risk in HIV-discordant couples were presented. One showed no cases of transmission in couples where the HIV-positive partner took antiretrovirals, while the other showed an 80% reduction in transmission risk.
Christophe Fraser, an epidemiologist from Imperial College, London, warned the confererence that the striking effect of universal treatment in mathematical models might not be replicated in real life if it proved less than 99% effective, and called for careful examination of the assumptions in the WHO models by other epidemiologists before policy is made.
Brighton CHAPS conference calls
And the recent UK gay men's sexual health conference CHAPS, in Brighton debated this. George House Trust's policy expert Chris Morley was one of a panel of speakers debating Treatment as Prevention.
Many people with HIV on treatment with an undetectable viral load are already rethinking condom use and telling partners. There are still some risks of HIV transmission - particularly if either partner has a sexually transmitted infection. But in ideal circumstances, it is pretty clear that the transmission risks with an undetectable viral load are not much worse than with using condoms consistently. People have a right to know the facts and to choose how to manage transmission risks and disclosure to suit themselves.
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