While the search for a vaccine is important, by testing and immediately treating people in high risk areas with antiretrovirals we could stop HIV spreading in five years and eradicate HIV/AIDS altogether in 40 years, says an expert who spoke at a conference at the weekend.
Dr Brian Williams, a research fellow at the South African Centre for Epidemiological Modeling and Analysis, made this point on Saturday at the annual meeting of the American Association for the Advancement of Science (AAAS) which takes place this year on 18 to 22 February in San Diego.
As estimates put the global number of people infected with HIV at 35 million, public health officials are starting to look beyond a vaccine as a way to halt the epidemic.
Williams suggested establishing universal, voluntary screening programs and immediate treatment with antiretrovirals would reduce the viral loads in people infected in high risk regions.
Advances in antiviral treatments have led to greater life expectancy for people living with HIV, but the problem as far as the epidemic is concerned, is that people living longer with HIV increases the potential for passing it onto others.
“We’ve been using drugs to save lives, but not stop the infection,” said Williams in an AAAS statement released late Saturday.
“It’s time to look beyond that,” he added.
He explained that proper treatment makes a person 25 times less infectious.
While there has been a rapid scale up in the provision of antiretrovirals, and in the last five years it has exceeded expectations, it has not reduced the rate of HIV-transmission and AIDS-related TB because the treatment is given too late in the course of the infection, said Williams.
Giving HIV-infected people the treatment much earlier would render them virtually non-infectious, he added, saying estimates showed such a test and treat plan could halt the spread of the virus in 5 years and eliminate HIV/AIDS altogether in 40 years.
Dr Kenneth H. Meyer, professor of medicine and community health at Brown University, said getting people onto antiretroviral treatments has met with some success, but the trend of more new infections and deaths will continue as infected people live loger, especially in high risk areas.
He cited estimates of infection rates in the United States, explaining that while overall the infection rate of HIV in the US is 1 in 300 people, in hot spots like Washington DC it is nearer 1 in 15. He also said up to a quarter of people infected with HIV in the US were unaware of it.
Meyer agreed that the need to treat people with antivirals to improve their quality of life and reduce the potential to spread it to others will rise, but the question is:
“Can we keep up?”
Another expert, Dr Dennis Burton, a professor of immunology and microbial science at Scripps Research Institute, said while prevention through antiretroviral programs is “incredibly important”, we should not give up the search for a vaccine, explaining there have been some exciting advances and that vaccines and antivirals are not at opposite poles.
If we could develop a vaccine, said Burton, then:
“It will mean great strides for vaccine development that will help our efforts to address the next disease.”
Williams said universal testing and antiretroviral treatment programs would need start-up funding and operational research.
According to a BBC News report, he said estimates put the cost of giving antiretrovirals to nearly 6 million HIV-infected people in South Africa in the region of 2 to 3 billion dollars a year.
“The only thing more expensive than this plan, for health care costs and deaths, is doing nothing,” said Williams.
Standard antiretroviral therapy (ART) is the administration of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus. According to the World Health Organization, a potent ARV regimen brings huge reductions in rates of death and suffering.
30 million people worldwide living with HIV are in low and middle income countries, says the WHO, whose latest figures (as of end of 2008) suggest that only 4 million of them had access to ART.
At the end of last year, WHO made a three-pronged recommendation to reduce the spread of HIV: earlier initiation of ART for adults and teenagers, prolonging the use of ARVs to reduce the risk of mother-to-child transmission, and for the first time, that HIV-positive mothers or their babies take ARVs while breastfeeding.
Sources: AAAS, BBC News, WHO.
Written by: Catharine Paddock, PhD