{"id":183,"date":"2008-11-30T16:55:00","date_gmt":"2008-11-30T21:55:00","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=183"},"modified":"2015-06-04T15:31:35","modified_gmt":"2015-06-04T19:31:35","slug":"how-to-end-the-hiv-epidemic","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/how-to-end-the-hiv-epidemic\/2008\/11\/30\/","title":{"rendered":"How to End the HIV Epidemic"},"content":{"rendered":"<p>Answer:\u00a0 Put everyone on treatment.<a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2008\/11\/matterhorn-zermatt-43281.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-185\" title=\"matterhorn-zermatt-4328\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2008\/11\/matterhorn-zermatt-43281.jpg\" alt=\"\" width=\"240\" height=\"161\" \/><\/a><\/p>\n<p>Conspicuously absent for decades, the <em>prevention<\/em> part of the &#8220;when to start antiviral therapy?&#8221; question has now moved front and center in two recent papers:\u00a0<\/p>\n<ul>\n<li>In this week&#8217;s <a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(08)61697-9\/fulltext\" target=\"_blank\">Lancet<\/a>, a group from the WHO estimated what would happen if there were annual universal HIV testing, and then immediate treatment for all found to be positive.\u00a0 They used South Africa &#8212; the country with the highest number of HIV cases &#8212; as a test case, and assumed heterosexual transmission of HIV.\u00a0 After going through the usual gyrations required in such mathematical models, they found that such a treat-everyone strategy would shift the HIV epidemic in South Africa from its current (dismal) phase to an &#8220;elimination\u00a0phase&#8221;\u00a0&#8212; \u00a0with an ending to\u00a0the epidemic feasible by 2020.<\/li>\n<li>This summer, researchers from Vancouver (of course from their Excellent &#8220;Centre for Excellence&#8221;) published a paper with <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18498241?ordinalpos=1&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum\">largely similar findings <\/a>&#8212; this time applied to an epidemic that is more typical of developed countries, predominantly\u00a0made up\u00a0of gay men and injection drug users.\u00a0 As with the WHO\/South Africa paper, there would be a high up-front cost of expanding therapy, but ultimately costs would be lower because of averted infections.<\/li>\n<\/ul>\n<p>The treatment-as-prevention theme, of course, got off to a roaring start this year when the Swiss National AIDS Commission <a href=\"http:\/\/www.aidsmap.com\/en\/news\/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp\">issued a statement <\/a>saying that people with HIV who are adherent to antiretroviral therapy, have undetectable plasma viral loads, and<sup> <\/sup>have no sexually transmitted infections are <em>not infectious to others.\u00a0 <\/em><\/p>\n<p>Very bold &#8212; especially for a country famous for chocolate, watches, and fondue.<\/p>\n<p>While the certainty of this statement struck some as extreme, and others as bordering on arrogant\u00a0 &#8212; and this <a href=\"http:\/\/aids-clinical-care.jwatch.org\/cgi\/content\/full\/2008\/922\/1\">single case report <\/a>is an example of how doctors should &#8220;never say never&#8221; &#8212;\u00a0the principle behind\u00a0the Swiss statement was sound, and quite helpful in getting the conversation started.\u00a0 Treatment <em>can<\/em> be prevention, and this is something we should discuss with each of our patients when reviewing the pros and cons of going on therapy.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Answer:\u00a0 Put everyone on treatment. Conspicuously absent for decades, the prevention part of the &#8220;when to start antiviral therapy?&#8221; question has now moved front and center in two recent papers:\u00a0 In this week&#8217;s Lancet, a group from the WHO estimated what would happen if there were annual universal HIV testing, and then immediate treatment for [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8,9],"tags":[77,332,412,423,736,750,939],"class_list":["post-183","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","category-policy","tag-antiretroviral-therapy","tag-epidemiology","tag-health-care-policy","tag-hiv","tag-policy","tag-prevention","tag-transmission"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/183","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=183"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/183\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=183"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=183"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=183"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}