Universal approach could eradicate HIV in South Africa
The elimination of HIV in South Africa could be possible 10 years earlier than under current antiretroviral treatment policy, as a result of an expanded universal test and treat approach. This is according to new research published in the journal PLOS Medicine.
According to the Human Sciences Research Council, there were approximately 6.4 million South Africans with HIV or AIDS in 2012. The prevalence of the virus increased from 10.6% in 2008 to 12.3% last year, emphasizing the need for preventive interventions.
A team of international researchers, led by Jan Hontelez from Erasmus MC, University Medical Center Rotterdam in the Netherlands, say that with the current antiretroviral treatment policy in South Africa, the human immunodeficiency virus (HIV) could be wiped out in the next 24-34 years.
But their new research suggests that access to antiretroviral therapy (ART) through a universal test and treat (UTT) approach could eliminate HIV 10 years earlier.
The UTT intervention involves an annual screening of people aged 15-years-old and over, alongside immediate ART for adults infected with HIV beginning in 2012 and increasing to 90% coverage by 2019.
ART is a treatment made up of a minimum of three antiretroviral (ARV) drugs to suppress HIV and halt the progression of the disease.
A person who is HIV-positive is usually started on ART when their CD4 count - a white blood cell - goes below 350 cells/μl blood.
However, according to the study authors, previous research has shown ART treatment of all HIV-positive individuals - regardless of their CD4 count - may reduce HIV transmission through reducing infection between HIV-positive individuals, a process deemed as "treatment as prevention."
From this, research has shown that expanding the ART process may lead to HIV elimination, but the time scales in which this could happen have differed.
Models 'simulated' HIV epidemic
For their study, the researchers assessed the UTT intervention by creating nine models that "simulated" the HIV epidemic in South Africa.
The models simulated sexual networks within South Africa, the stages of HIV within the country with varied degrees of infectiousness, and incorporated treatment effectiveness predictions in order to determine a time frame for the elimination of HIV.
All models were found to replicate the prevalence of HIV in South Africa between 1990 and 2010, and they all predicted that UTT would eliminate HIV to less than one new infection per 1,000 person-years.
The analysis revealed that the simplest model would eliminate HIV after 7 years, while the "more complex and realistic" models predicted elimination at significantly later points.
However, the researchers note that importantly, although the most comprehensive model revealed that HIV would be eliminated after 17 years of UTT, it also showed that initiating ART for HIV-positive people regardless of their CD4 count may also lead to elimination alone, but 10 years later.
Explaining their findings, the researchers say:
"Our results confirm previous predictions that the HIV epidemic in South Africa can be eliminated through universal testing and immediate treatment at 90% coverage.
However, more realistic models show that elimination is likely to occur at a much later point in time than the initial model suggested. Also, UTT is a cost-effective intervention, but less cost-effective than previously predicted because the current South African ART treatment policy alone could already drive HIV into elimination."
The researchers conclude that analysis of results from upcoming community randomized trials for "treatment as prevention" are to be evaluated with models that look at the strategy in detail, to determine its overall impact and cost-effectiveness.
Medical News Today recently reported on a study suggesting that an antifungal drug could eradicate HIV in cells.
Written by Honor Whiteman
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