To mark World AIDS Day yesterday, researchers engaged in a “thought experiment” meant both to demonstrate the challenges and the possibilities confronting a world beset by the HIV virus. What would happen, they asked, if everyone was tested annually for HIV, and all people with positive results were immediately put on antiretroviral drugs? In a new study published in the journal The Lancet [subscription required], researchers predicted what the effects of such a policy would be in South Africa. They worked out that treating everyone with the virus with antiretroviral drugs would reduce incidence from 20 per 1000 people to just 1 per 1000 within 10 years…. That’s because the drugs keep levels of the virus in the blood down, making people less infectious – even if they have unsafe sex [New Scientist].
Currently, people have to seek out HIV tests, and those who don’t engage in high-risk behavior (like unsafe sex or intravenous drug use) often never get tested. In addition, the expensive antiretroviral drugs currently aren’t prescribed to HIV-positive patients until their immune systems are compromised and they begin to show symptoms of AIDS. The researchers argue in their article that present policies aren’t working, as 33 million people around the world are currently infected with HIV. The American College of Physicians also released new recommendations this week, advising doctors to routinely screen all patients if possible.
Whether the suggested policy of annual testing and immediate treatment would work in practice is uncertain. It is not clear how one could persuade people who are not feeling sick to get tested every year and to undergo long-term drug therapy if they test positive. The cost of testing and treating so many people would be high. And the drugs can be toxic with prolonged use. Their effectiveness can be undermined if resistant strains of the virus develop [The New York Times].
But the World Health Organization researchers who conducted the study argue that the cost of universal testing and treatment shouldn’t be considered one of the roadblocks. The study suggests that the cost would peak at $3.4 billion a year in 2015. But this is no more expensive than current plans to tackle HIV by providing universal access to prevention, care and treatment…. “In the longer term, the modelling suggests it would actually become cost saving” [Nature News], says WHO scientist Kevin De Cock.
The WHO will continue to discuss the idea of universal testing, although it is not yet recommending it. If the policy shift does eventually take effect, it would have the greatest impact in sub-Saharan Africa, where about 80 percent of adults with HIV or AIDS don’t know that they are carrying the virus, and where health ministries stress prevention through safe sex and circumcision rather than treatment with expensive drugs.
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Image: flickr / troismarteaux