July 15, 2011
A top AIDS expert says the best way to control the epidemic is to use antiretroviral drugs as a prevention tool. The "treatment as prevention" strategy will be highlighted at next week's AIDS conference in Rome.
Dr. Julio Montaner says the strategy "has progressed from a testable hypothesis to an urgent implementation priority."
"We originally came with the recommendation for treatment as prevention back in 2006. We felt at that time that the data was compelling enough to make that recommendation," he said.
It was a policy put in place in Vancouver, Canada, where Montaner heads the British Columbia Center for Excellence in HIV/AIDS.
"A lot of people felt that further evidence was needed, that the naysayers had reservations and so on and so forth. We estimated at that time that treatment could prevent more than 90 percent of the transmission of HIV that we see in the world. Earlier treatment decreases morbidity and mortality among those infected with HIV. But secondarily, it decreases HIV transmission," he said.
Evidence
Dr. Montaner will speak at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Rome. It runs from July 17th to the 20th. He is the former head of the International AIDS Society and has written about the prevention strategy in The Lancet, a British medical publication.
Recent studies have supported his views. For example, two studies done in Kenya, Uganda and Botswana show that a single pill containing two drugs, taken daily, can prevent an uninfected person from HIV transmission. It's called pre-exposure prophylaxis, or PrEP, and it has a protection rate as high as 73 percent.
Another study shows that when infected people get on treatment early and stay on it, they are much less likely to infect another person during sex. Montaner says the results of a long-term study by the US National Institutes of Health show a protection rate of 96 percent. Those results will be formally released in Rome.
"Let's go with it and we'll see how we can control HIV within this decade," he said.
Promises past and present
In 2005, at the G8 summit in Gleneagles, Scotland, leaders pledged to have universal access to HIV treatment by 2010. That didn't happen. Last month, a high-level UN meeting also committed to providing universal access to 15 million people by 2015.
"Is the political leadership at the global level going to deliver on their promise or is it going to be the same as it happened when they had previously promised universal access to treatment by 2010? And we fell short by a third to a half and there was not even an apology," he said.
"The evidence is in," Montaner said. "Treatment is prevention." He rejects arguments that it would too expensive to put millions more people on antiretroviral drugs as a prevention measure. He says in the long run, it would not only save a lot of money, but also save a lot of lives.