Antiretrovirals and HIV Prevention

by Alanna Shaikh · 2009-07-06 09:27:00 UTC
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(Children living with AIDS. Photo credit: Cambodia4Kids)

The evidence is mounting in favor of the earliest possible initiation of anti-retroviral therapy (ART) for people with HIV. We've already seen that survival rates radically improve if we start the drugs sooner. Now we also know that transmission decreases, too. That makes early initiation of HIV drugs gold standard policy - it benefits both the individual patients and the population as a whole. (Or, in jargon terms, provides both a medical and a public health benefit.)

The most recent WHO bulletin discusses using antiretrovirals to reduce HIV transmission. They argue that HIV is only transmitted from people who have the infection. Therefore, it is far easier to treat them than it is to try and get the larger, uninfected population to change their behavior. They offer prevention of mother to child transmission as evidence that ARTis effective at reducing transmission rates. As an added bonus, earlier ART also seems to reduce the rate of tuberculosis co-infection.

It's not easy, of course, to just start increasing the number of people who get ART. There is the financial barrier - these drugs cost money, and a capacity barrier. Prescribing HIV drugs is still a complex process which requires a lot of skill and a lot of data. The data includes both up to date information on drugs and therapies, but also the results of blood tests which may not be available on the developing world. The WHO summarizes "Formidable challenges to such an approach include conducting the necessary research; operational and financial feasibility; ethical and human rights challenges, acceptability; and the potential for drug resistance and toxicity."

For once, however, I will end on a note of optimism. This really could be what we need to stop the pandemic. The WHO states that "in an HIV/AIDS epidemic of southern African severity, universal voluntary HIV testing on an annual basis followed by immediate ART could reduce HIV incidence by about 95% within a decade, with cost-saving over the medium term." That's world-changing.

Alanna Shaikh
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