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Treatment as prevention: what are the next steps?
Keith Alcorn, 2011-07-20 08:20:00
Turning treatment into a prevention tool that can end the HIV pandemic will require not one, but a host of different improvements, in the delivery of health care to achieve its full impact, and will not succeed without full respect for the human rights of people with HIV, the Sixth International AIDS Society conference heard this week in Rome.
Following Monday’s comprehensive presentation of results from HPTN 052, the landmark study which showed that early treatment of HIV-positive people reduced the risk of HIV transmission to their partners by 96%, experts have reviewed some of the challenges in translating these results into action.
Professor Julio Montaner of the University of British Columbia, a long-time champion of treatment as prevention, pointed to the first hurdle: the fact that many people with HIV do not know of their infection, and even if they do, many others are either not in regular care or not on treatment.
Only 19% of HIV-infected people in the United States are estimated to have an undetectable viral load, Prof. Montaner noted.
Furthermore, 21% of the population of HIV-infected are unaware of their HIV status, yet they are estimated to account for 54% of onward infections in the United States.
Similarly, in Mozambique, a study that tracked patients from HIV diagnosis through the medical system found that, of 7005 patients who tested positive, 57% were still in care 30 days later. Of these, 77% had a CD4 cell count to determine if they were eligible for antiretroviral treatment (ART). Half of these patients were eligible for ART, and 471 of these 1506 patients actually started ART within 30 days. Of the original 7005 patients, just 317 made it onto ART and were then adherent for at least six months.
Getting all parts of the process, from the offering of an HIV test through referral to care, starting treatment and ensuring long-term adherence to treatment, will be critical for ensuring that the proportion of people with suppressed viral load is as high as possible.
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