IAS Urges New Focus on ART as Prevention, Calls for Immediate Global Action and Funding for Universal Access to HIV Therapy
November 4, 2009
Geneva, Switzerland -- The International AIDS Society (IAS) today saluted the World Health Organization (WHO) for its focus on scaling up antiretroviral therapy (ART) as prevention as well as for treatment. The WHO consultation that concluded today has reaffirmed the urgent need for universal access to ART for the treatment of people living with HIV, emphasizing the clinical benefit of early treatment for individuals, as well as the prevention impact of increased access to ART in reducing HIV transmission and tuberculosis (TB) incidence. The IAS's statement came at the end of a three-day consultation on ART for HIV Prevention convened by WHO.
ART significantly reduces HIV viral load, thereby reducing the risk of HIV transmission. In high-income countries, ART has virtually eliminated transmission of HIV from mothers to their babies, and a number of studies indicate that universal provision of ART to people living with HIV would have a major impact on reducing HIV transmission and TB incidence globally.
A recent mathematical model by Granich et al (WHO, 2009) also has proposed that universal, voluntary HIV testing on an annual basis, immediately followed by ART for all persons who test positive, would likely result in a 95 percent reduction in annual HIV incidence globally within 10 years.
Importantly, the health benefits of universal access to ART are not limited to reducing HIV illness and transmission. Earlier initiation of ART has also been associated with better survival, improved tolerability of therapy, and improved immune response, and has been shown to reduce the transmission of tuberculosis among HIV-infected individuals.
"In addition to saving lives and improving individual health, HIV therapy has tremendous potential to improve health at the community level, by reducing HIV transmission and the incidence of tuberculosis, which continues to be a major killer in low- and middle-income countries" said IAS President Dr. Julio Montaner, Director of the BC Centre for Excellence in Vancouver, Canada. "But the promise of ART, to save lives and reduce millions of new HIV infections, will not be fulfilled without immediate follow-through on the commitment to universal access made by the G8 nations in 2005. That commitment comes due in 2010, and we are still far from able to reach all those in need of therapy quickly and effectively."
The UN's most recent progress report on universal access indicates that less than half of all people living with HIV in the world who could benefit clinically from ART have access. WHO treatment guidelines call for the initiation of ART at a relatively late stage of HIV disease, when an individual's immune system has already been weakened substantially by the virus. These guidelines will change soon, and new guidance is expected to urge earlier initiation of ART.
Noting that demand for ART access, and associated costs, will increase significantly as programmes adopt the clinically sound CD4 threshold of 350 cells/mm3 as a starting point for ART, Montaner added that "savings from reduced HIV transmission, increased wellbeing, and decreased illnesses and hospitalizations make such a move not only feasible but also fiscally sound. Our models suggest that this can be a highly cost-effective strategy."
The IAS specifically called for increased operations research on the preventative benefits of more widespread treatment scale up, including continued support for the 2007 Sydney Declaration, which was adopted at the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention. The declaration urges that 10 percent of all resources dedicated to HIV programming from granting agencies and national health budgets be allocated for operations research to improve HIV interventions.
"At every step along the way to universal access, the scale-up of HIV treatment should be guided by operations research," said IAS Executive Director Robin Gorna. "Such research will ensure that the implications of more widespread HIV testing and treatment -- including its implications for equity, human rights, morbidity and mortality, and the preventative impact of ART on HIV transmission -- are informed by evidence of what works best."
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