Roll out treatment as prevention now to stop HIV and AIDS

The publication of the editorial comment coincides with the opening of the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) taking place in Rome, Italy from June 17-20. The conference, the biggest open scientific AIDS conference in the world, will feature numerous presentations on Treatment as Prevention.

The commentary – by Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS (BC-CfE) and Past President of the International AIDS Society (IAS) – strongly reinforces the view that the benefits of highly active antiretroviral therapy (HAART) extend beyond the remarkable effectiveness of the treatment to prevent the onset of AIDS and prolong life, to dramatically reduce HIV transmission.

Based on HAART's effectiveness in reducing transmission, Dr. Montaner is calling on the international community to support an immediate and expanded roll out of HAART under the Treatment as Prevention strategy, as pioneered by the BC-CfE in British Columbia, Canada.

"Treatment as Prevention is one of the most important and promising additions to the range of prevention strategies available to us today," said Dr. Elly Katabira, President of the IAS and Chair of IAS 2011. "Dr. Montaner's column is a rallying call for the universal endorsement and funding of this approach for the benefit of our future generations."

The Treatment as Prevention strategy advocates for widespread HIV testing and facilitated access to free HIV treatment for all medically eligible HIV-positive individuals. Current HIV treatment reduces the level of HIV in the blood to undetectable levels, thus improving the health of HIV-positive individuals. At the same time, the treatment decreases the level of HIV in sexual fluids to undetectable levels, thereby reducing the likelihood of HIV transmission by over 90 per cent.

"The evidence is clear: treatment conclusively prevents morbidity, mortality and transmission," said Dr. Montaner. "We now have ample and compelling evidence that treatment prevents HIV transmission during pregnancy and breastfeeding, as well as in sexual and injection drug use settings. The challenge remains to optimize the impact of this valuable intervention. Failure to do so is not an option."

A recent study by the US National Institutes of Health (NIH) reported that immediate use of HAART led to a 96% decrease in the risk of HIV transmission among heterosexual couples where one partner is HIV positive.

"These results are a real scientific breakthrough and a game changer in the response to HIV," said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "We must embrace Treatment as Prevention as part of a combination prevention strategy to achieve our collective vision of zero new infections and zero AIDS-related deaths."

The Treatment as Prevention model has been embraced by UNAIDS and the World Health Organization within the Treatment 2.0 initiative, announced last year as a central pillar of the global strategy to respond to HIV.

In February 2011, in consultation with the BC-CfE and the Chinese Centre for Disease Control and Prevention (China CDC), China became the first country to incorporate Treatment as Prevention as part of its national HIV/AIDS strategy to control HIV/AIDS over the next five years.

More information: http://www.thelancet.com, Vol 378 July 16, 201, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60821-0/abstract

Provided by International AIDS Society