WEDNESDAY, Nov. 26 -- A combination of universal voluntary HIV testing and
immediate antiretroviral treatment (ART) following diagnosis of HIV
infection could reduce HIV cases in a severe generalized epidemic by 95
percent within 10 years, a World Health Organization study finds.
The researchers used computer modeling to examine the impact of testing all
people aged 15 years and older for HIV every year and starting ART
immediately after a person is found to be infected with HIV, the virus that
causes AIDS. Data from South Africa was used as a test case for a
generalized epidemic, and the model assumed all HIV transmission was
heterosexual.
"Instead of dealing with the constant pressure of newly infected people,
mortality could decrease rapidly and the epidemic could begin to resemble a
concentrated epidemic with particular populations remaining at risk. The
focus of control would switch from making ART available to people with
greatest need to providing support and services for those who are receiving
ART. Transmission could be reduced to low levels, and the epidemic could go
into a steady decrease towards elimination as those receiving ART grew
older and died," wrote Dr. Reuben Granich, of the WHO's department of
HIV/AIDS, and colleagues.
"Although other prevention interventions, alone or in combination, could
substantially reduce HIV incidence, our model suggests that only universal
voluntary HIV testing and immediate initiation of ART could reduce
transmission to the point at which elimination might be feasible by 2020
for a generalized epidemic, such as that in South Africa. This analysis
lends support to, and extends, earlier analyses suggesting that rapid
scale-up of conventional ART approaches could greatly reduce mortality and
have a substantial effect on HIV incidence."
They said this approach "merits further mathematical modeling, research,
and broad consultation."
The study was published online and in an upcoming print issue of The
Lancet.
In an accompanying comment on the study, Professor Geoffrey P. Garnett of
Imperial College London, U.K., wrote that this type of HIV control strategy
"would reflect public health at its best and its worst."
"At its best, the strategy would prevent morbidity and mortality for the
population, both through better treatment of the individual and reduced
spread of HIV," Garnett wrote. "At its worst, the strategy would involve
over-testing, over-treatment, side-effects, resistance, and potentially
reduced autonomy of the individual in their choices of care. The individual
might gain no personal benefit from testing and early treatment, but they
would benefit from protecting partners -- and who could object to that,
unless they were recklessly exposing others to infection?
"It is easy to see how enforced testing and treatment for the good of
society would follow from such an argument. Partial success would lead to
infection becoming concentrated in those with a high risk, with an
increased danger of stigma and coercion," Garnett wrote.
More information
The U.S. Centers for Disease Control and Prevention has more about HIV/AIDS
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http://www.cdc.gov/hiv/resources/qa/index.htm .
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