Could a new approach end AIDS cases by 2050?

Since a successful AIDS vaccine is still far from the horizon, scientists are suggesting that getting aggressive with the early detection and treatment of the virus with early anti-retroviral therapy could have a huge impact on this global health issue. If executed properly, some researchers believe, the "test and treat" strategy could end new HIV/AIDS cases within 40 years. That was the assertion made by professor Brian Williams of the South African Center for Epidemiological Modeling and Analysis, speaking recently at the American Association for the Advancement of science meeting in San Diego.

The proposal would entail almost universal HIV testing, and would require those found to be HIV positive to begin a lifelong regiment of anti-retroviral drugs at once. Another professor speaking at the conference, professor John Hargrove, director of SECEMA in Stellenbosch, emphasized that this approach would indeed be a departure from current methods of preventing the spread HIV/AIDS, which generally focus on helping people avoid contracting the disease in the first place - by advocating condom use, etc. But Hargrove says that targeting people newly infected could have an even bigger impact: "If you reduce the viral load, the amount of virus in the blood, then you radically reduce the infectiousness. So, if in fact you get people very soon after they are HIV positive and put them on anti-retrovirals, you reduce the aggregate viral load in the entire population. And therefore you will reduce the rate at which new infections occur."

According to the World Health Organization, as of December 2008, there were 33.4 million people worldwide infected with HIV. The WHO seems to embrace a comprehensive report of prevention and treatment, so it will be interesting to see whether it endorses this treatment-focused approach to stamping out the virus. UNAIDS, the joint United Nations program on AIDS, continues to emphasize prevention efforts, and reports that "The common failure to prioritize focused HIV prevention programmes for key populations is especially apparent. Even though injecting drug users, men who have sex with men, sex workers, prisoners and mobile workers are at higher risk of HIV infection, the level of resources directed towards focused prevention programmes for these groups is typically quite low, even in concentrated epidemics."

In addition to being logistically tricky, the proposed plan of testing as much of the world population as possible also introduces privacy concerns. The professors urging the new strategy stop short of recommending that HIV testing be mandatory - instead they advise only that health professionals and organizations strongly urge people to get tested.