International health officials are considering a radical shift in the war against HIV and Aids that would see every-one tested for the virus and put on a lifetime course of drugs if they are found to be positive.
The strategy, which would involve testing most of the world’s population for HIV, aims to reduce the transmission of the virus that causes Aids to a level at which it dies out over the next 40 years.
Brian Williams, professor of epidemiology at the Centre for Epidemiological Modelling and Analysis in Stellenbosch claimed that transmission of HIV could effectively be halted within five years with the use of antiretroviral (ARV) drugs.
‘The epidemic of HIV is one of the worst plagues of human history,” he told a meeting of the American Association for the Advancement of Science in San Diego. ‘I hope we can get to the starting line in one to two years and get complete coverage of patients in five years. Maybe that’s being optimistic, but we’re facing Armageddon,” he said.
Major trials of the strategy are planned in Africa and the United States and will feed into a final decision on whether to adopt the measure as public health policy in the next two years.
The move follows research that shows that the blanket prescribing of ARVs could stop HIV transmission and halve cases of Aids-related tuberculosis within 10 years. More than 30-million people are infected with HIV globally and two million die of the disease each year.
Although ARVs have been a huge success in preventing the virus from causing Aids, scientists estimate that only 12% of those living with the infection receive the drugs. The disease is prevalent in sub-Saharan Africa, which accounts for a quarter of all HIV/Aids cases globally. Half of these are in South Africa.
A person with HIV infects between five to 10 others before succumbing to the complications of Aids. Treating patients with ARVs within a year of their becoming infected can reduce transmission tenfold, enough to cause the epidemic to die out.
In the trials people will be offered HIV tests once a year, either as routine when they visit their GP, or through mobile clinics in more remote regions. Those who test positive will be put on a lifetime course of ARVs.
‘Over the past 25 years we have saved the lives of probably two to three million people using antiretroviral drugs, but almost nothing we have done has had any impact on transmission of the disease,” Williams said.
‘We have stopped people dying, but we haven’t stopped the epidemic,” he said. If patients take ARVs as prescribed, the amount of virus in their bodies can fall by 10 000 times to a level at which they are extremely unlikely to pass it on.
‘The question is, can we use these drugs not only to keep people alive, but also to stop transmission? I believe we can. We could effectively stop transmission of HIV in five years,” Williams said.
Scientists estimate that the cost of the strategy in South Africa alone would be between $3-billion and $4-billion a year (about R23.3-billion and R31-billion). The world spends $30-billion (about R223.25-billion) a year on Aids research and treatment, a cost that some experts believe will double in the next decade.
Sub-Saharan Africa has seen a big rise in cases of tuberculosis among HIV patients, who are susceptible to other infections because their immune systems have been weakened.
‘If you factor in all of the costs, in my opinion doing this would be costsaving from day one,” said Williams. ‘The cost of the drugs would be more than balanced by the cost of treating people for all of these other diseases and then letting them die.
‘We’re killing probably half a million young adults every year, in the prime of their life, just at the point where they should be contributing to society, and the cost of that to society is enormous. ‘The only thing that ‘s more expensive than doing this is not doing this.”
HIV patients in Southern Africa are more likely to take ARVs when they should than people living in developed countries, according to health officials.
The finding gives doctors hope that the blanket administering of drugs might suppress the virus enough that it dies out naturally. Last year scientists reported the marginal success of an HIV vaccine following a large-scale trial in Thailand.
The vaccine benefited only 31% of those who received it. A vaccine is generally regarded as
worthwhile if it protects more than 70% of those treated. —