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Aids: the end in sight?
Feb 25, 2010

Dear Dr. Bob,

What do you think of the recent statement from Dr. Brian Willams of the South African Center for Epidemiological Modelling and Analysis who asserts that HIV could be wiped out in approximately 40 years with widespread testing and anti-viral treatment starting immediately for anyone infected?

Apparently, his idea will be tested in an upcoming clinical trial in South Africa. He was stating some monetary figures to make that happen (treating everyone) but I recall that you stated previously on www.thebody.com that you think (in monetary terms to expensive) that treating like this wouldn't eradicate the virus but an emphasis on a vaccine would. Any thoughts?

As always, much love & happiness to you & Steve,

janelle

Response from Dr. Frascino

Hello Janelle,

Well, for one thing it sounds almost too good to be true, and in the real world it may prove to be exactly that. However, conceptually I have been intrigued by this idea since it was first proposed by researchers at the World Health Organization and published in the medical journal Lancet last year.

The researchers developed a mathematical model to predict what would happen if most adults and sexually active adolescents were HIV-antibody tested every year and those who tested positive were immediately treated with potent combination antiretroviral therapy (as opposed to delaying treatment until the immune system becomes deficient, as the policy stands now).

The results were nothing short of breathtaking! They indicated HIV transmission would be nearly eliminated within a decade! This would occur because the antiretroviral therapy would drive the viral load down, thereby drastically decreasing HIV-transmission risk.

The reason I stated this might be too good to be true in the real world involves logistics and upfront costs. How could we persuade folks who do not feel the least bit sick to get HIV tested every year? How do we get the folks to test HIV positive to commit to and adhere to long-term potent combination antiretroviral therapy that may cause side effects and toxicities! Who will pay the upfront costs of testing and treating vast numbers of people? What will happen if many folks start treatment, but are noncompliant? This could lead to increased drug-resistant strains of HIV.

It's interesting to note that in the long run, the researchers pointed out this approach is actually cheaper than the current practice of waiting to treat HIVers until their disease reaches an advanced stage.

One thing that truly excites me about this concept is that it combines treatment and prevention. There has long been a battle for the limited dollars available between those fighting for treatment and those fighting for prevention. The concept proposed by the researchers is a combined approach that actually uses treatment as prevention against further transmission. I, for one, think that's a brilliant idea!

Dr. Bob



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