Antiretrovirals Can Be Used to Prevent Spread of HIV/AIDS, Model Shows
July 21, 2009
In addition to acting as life-saving therapy to people living with HIV/AIDS, WHO researchers say antiretrovirals (ARVs) may also be able to prevent the spread of HIV, Health-e/allAfrica.com reports. Reuben Granich, of the WHO, used a model to estimate the use of ARVs for the prevention of HIV transmission, and presented his findings to delegates gathered at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention meeting in Cape Town, South Africa (Thom, 7/20).
"Granich argued that, because antiretrovirals can lower an HIV-positive person?s viral load to undetectable levels, the drugs could be used to make HIV-positive people virtually non-infectious -- which could slash HIV transmission rates to levels at which it could eventually be eliminated," the Times reports. "WHO researchers first raised the concept in a paper published in the journal Lancet medical journal late last year. The Cape Town gathering is the first big conference to debate it" (Keeton, 7/21).
The idea of using "treatment as prevention" has long been supported by Julio Montaner, president of the IAS, the Globe and Mail reports in a piece that examines how the Canadian scientist's "once-ridiculed idea" has come to win the support of international health experts (York, 7/21).
Health-e/allAfrica.com: "Granich said universal voluntary counseling and HIV testing coupled with immediate initiation on ARVs, combined with other prevention methods would see a 95 percent reduction in new HIV cases in 10 years, incidence would reduce from around 20,000 per million to around 1,000 per million people and the number of people living with HIV would become less than 1 percent by 2050" (7/20).
"Immediate treatment is a bold concept that deserves serious consideration," Tony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said of the new model, the Times reports. "We will be doing research to determine the feasibility of several assumptions underlying it" (7/21).
Study Shows Earlier Treatment for HIV-Positive Patients in South Africa Would Saves Lives, Be Cost-Effective
Also during the conference, researchers presented data that showed "[e]arlier treatment for HIV infection in South Africa could prevent nearly 76,000 deaths and avert 66,000 opportunistic infections over the next five years," Reuters reports. The findings, based on a mathematical model, revealed "starting treatment earlier would not only save lives but would be more cost-effective than delaying treatment, saving $1,200 for every year of life saved" (Steenhuysen, 7/20).
For people living with HIV in developing countries, "[t]he WHO recommends starting HIV treatment when a patient?s CD4 cells -- the infection-fighting cells the virus attacks -- drop below 200 per cubic millimeter of blood, to delay the costs and side-effects associated with the drugs," Bloomberg writes. However, HIV-positive patients in developed countries begin HIV treatments when CD4 counts fall below 350 (Bennett, 7/20).
"While those standards accommodate the limited resources and short supply of medications in many settings, the greater prevalence of tuberculosis and other opportunistic infections in places like South Africa argue for earlier treatment initiation," study author Rochelle Walensky of Massachusetts General Hospital and Harvard Medical School, said in a written statement, according to Reuters. "Nearly 3 million people in the developing world now get HIV drugs -- about 70 percent of those who need them, according to the United Nations," Reuters reports (7/20).
Bloomberg writes, "Raising the threshold to 350 for patients in developing nations would be 'more appropriate and clinically sound,' said Julio Montaner ... in a speech at the group's conference in Cape Town yesterday" (7/20).
Study Finds Blood Tests for Africans on ARVs Unnecessary
"Hundreds of thousands more Africans with HIV could be treated without extra spending if blood tests for monitoring side effects are abandoned, the biggest trial of HIV therapy in the continent has found," the Times reports. The findings, based on a six-year clinical trial involving over 3,300 participants, revealed that patients who received regular laboratory tests in addition to ARVs had similar survival rates to those who received ARVs without routine testing. The data were presented during the IAS Conference (Henderson, 7/21).
BBC writes: "British International Development Minister Mike Foster said that while [ARV] treatment saves lives, the cost of the accompanying laboratory tests 'significantly reduces the number of people that this treatment can reach.' 'Crucially, the money saved from paying for these tests could enable more people to safely receive treatment, including those who for whatever reason are unable to travel to the laboratories,'" he said (BBC, 7/21).
Reuters Examines How Global Economic Crisis Will Impact Global Fund
Reuters examines how the "global economic downturn and recession in the U.S. and other G8 countries, coupled with demand that has 'quadrupled'," will impact the goal of the Global Fund to Fight Aids, Tuberculosis and Malaria to receive $30 billion next year. "My concern is about our ability to scale up because the [AIDS] epidemic spreads faster than our ability to scale up with the funding," Michel Kazatchkine, executive director of the Global Fund said. "I have no signal that donors would take back or would not honour to what they have committed (to 2010). The fact is that the demand is much higher" -- which he estimated would cause a funding gap of about $3 billion for programs in 2010 (7/20).
UNAIDS Head Talks to Health-e/allAfrica.com
Michel Sidibe, executive director of UNAIDS, discussed the importance of universal access to ARVs with Health-e/allAfrica.com. Sidibe has been on a "fact finding trip to southern Africa" and believes "AIDS needs to removed from isolation and become an entry point to transforming society, attaining the Millennium Development Goals, uplifting health systems and ultimately making better health and development outcomes a reality," according to Health-e/allAfrica.com (Thom, 7/20).
The International AIDS Society is providing regular updates on the latest conference developments and resources along with featured guest posts on the IAS 2009 Live blog.
This article was provided by Henry J. Kaiser Family Foundation. It is a part of the publication Kaiser Daily Global Health Policy Report. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.