Treatment as a Prevention Tool: Expansion of Highly Active Antiretroviral Therapy Programs Could Substantially Reduce New HIV Infections
August 5, 2008
HIV/AIDS experts gather at the XVII International AIDS Conference (AIDS 2008) to discuss the potential of HAART therapy as an aid to HIV prevention. Recent study shows that increasing HAART coverage from the current level of 50% of those medically eligible to 75%, could reduce new HIV infections by more than 30 per cent.1
Mexico City, Mexico -- A Canadian study by the BC Centre for Excellence in HIV/AIDS (BC-CfE) reveals the dramatic impact that increased coverage with HIV therapy could have in reducing HIV transmissions while saving money for health care systems around the globe, experts said today at the XVII International Conference on AIDS (AIDS 2008) currently convening in Mexico City. The study, Expanded Access to Highly Active Retroviral Therapy: A Potentially Powerful Strategy to Curb the Growth of the Epidemic, has attracted major interest internationally.
"We've known for some time that the expansion of coverage with HAART could help to reduce the number of new HIV infections. However, we were amazed at the actual number of new infections that can be potentially averted by expanding access to treatment," said BC-CfE director Dr. Julio Montaner, who is also the IAS President-Elect.
"We believe that the recent decision by the provincial government of British Columbia, Canada to adopt an aggressive strategy to extend access to HAART treatment shows their global leadership and commitment in the fight against HIV/AIDS. This is the right thing to do to benefit those infected with HIV, and to decrease the number of new infections. We anticipate that this decision will have major implications for the roll out of HAART around the world", he continued.
The study, published in The Journal of Infectious Diseases, used a novel mathematical model to assess the potential effects of increased treatment coverage with HAART among HIV-positive individuals in medical need of treatment in British Columbia, Canada. The model is reflective of the next 25 years.
According to the study, an increase in HAART coverage from the current level of 50 per cent among those in medical need, to 75, 90 and 100 per cent could lead to a decrease in the annual number of individuals testing newly HIV positive for the disease by over 30, 50 and 60 per cent respectively.
"Basically, the more people you treat and the faster you engage people in treatment, the greater impact you will have on the epidemic," added Montaner.
Dr Myron Cohen, distinguished Professor of Medicine, Microbiology, Immunology and Public Health at the University of North Carolina (UNC) and also the Associate Vice Chancellor for Medical Affairs-Global Health, said HIV prevention was more important today than ever.
"Regardless of the terrific increase in HIV treatment options worldwide, we cannot treat our way out of the epidemic. We need to use all the prevention options available now, and for once and for all marry treatment and prevention. This is essential to get the most from the HIV care community, and because antiretroviral drugs are likely to play an important role in HIV prevention," concluded Cohen.
The study's findings will help to re-energize and sustain the roll out of HAART programs throughout the world. While welcoming the JIC study and it's possible implications for treatment delivery globally, Stephen Lewis, Co-Director of Aids-Free World said past experience indicated that the adequate implementation of treatment programs in different settings across the globe was going to be a major challenge.
"We still have millions of people in need of treatment. We have two years to reach universal access. This study proves why we should be working harder towards that goal. ART as a prevention tool represents an opportunity to galvanise decision makers but we also need to take into account as always that treatment needs to be part of a comprehensive approach -- there's no point having effective ART in African communities for instance if nutrition and food security concerns are not addressed at the same time," said Lewis.
In Africa, the implications of the HAART study was welcomed by Dr Elly Katabira, Associate Professor of Medicine, Makerere University, who is also the President Elect (2010) of the International AIDS Society.
"Most of our patients we initiate on ART are very sick and some have been close to death," said Katabira. "Successful treatment makes them excellent advocates for both treatment and prevention. They would not want themselves or anyone else to be where they have been."
HAART consists of taking three (or more) antiretroviral drugs on a daily basis for life. HAART has led to a dramatic decrease in morbidity and mortality among individuals infected with HIV, and international guidelines widely recommend that HAART be used before overt immune deficiency is apparent. A recent study published in the last issue of The Lancet by Dr Robert Hogg, also from the BC Centre for Excellence in HIV/AIDS reported that HAART drug therapy helped patients live an average of 13 years longer.2
Notes to Editor
This article was provided by International AIDS Society. Visit International AIDS Society's website to find out more about their activities, publications and services.