Drugs Alone Can't Control HIV Epidemic

New research suggests that AIDS drugs alone cannot control the spread of HIV in established epidemics. Dr. Ronald H. Gray of Johns Hopkins University and colleagues used data from studies in Uganda to develop a model to predict the impact of AIDS drugs or an HIV vaccine on the course of the HIV epidemic in the Rakai district. The study, "Stochastic Simulation of the Impact of Antiretroviral Therapy and HIV Vaccines on HIV Transmission; Rakai, Uganda" appeared in AIDS (2003;17;(13):1941-1952).

Under current treatment standards, the researchers found, AIDS drugs alone could not control the epidemic. Treatment of 75 percent of eligible patients could result in a 7 percent decline in the HIV-infected population, the scientists discovered. The epidemic could actually be controlled only if all HIV-positive persons were treated.

An HIV vaccine alone could stop the epidemic, the investigators noted, but it would have to be very effective. A less effective vaccine, combined with AIDS drugs, could bring the epidemic under control. However, the study cautioned, none of those strategies would work if people engaged in risky behaviors because they felt their risk of infection was low.

"We cannot rely on treatment to control the epidemic," Gray said in an interview with Reuters Health, "and we need to plan for an ever increasing population of persons requiring treatment in the future." He noted that resources assigned to HIV treatment and prevention are inadequate. "If there is investment in treatment at the cost of prevention," he stated, "the epidemic cannot be controlled. We need to balance humanitarian considerations against public health priorities," he concluded, "and I am concerned that emphasis on treatment may distort this balance."

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