Washington Post (11.26.08) - Thursday, December 11, 2008
David Brown

The research builds upon previous studies showing that ARV treatment lowers the amount of HIV in an infected person's bloodstream to one-millionth what it would be without treatment, thus making the patient much less infectious. The study concludes that such a program would cut the rate of new HIV cases from 20 per 1,000 persons per year to 1 per 1,000 in about a decade.

Starting treatment at once, instead of when CD4 cell counts drop below 350, as is currently recommended, would cut the number of AIDS-related deaths from 8.7 million under the present strategy to 3.9 million by 2050.

The study also took into account the number of people expected to drop out of treatment and the number who would have to switch regimens due to drug resistance.

Based on data from South Africa and Malawi, the mathematical model's conclusions apply only to the type of epidemic seen in sub-Saharan Africa, where nearly all HIV transmissions occur through heterosexual intercourse. It is not known whether the findings would apply in settings where the major transmission modes are anal intercourse between men and intravenous drug use.

The aggressive strategy would prevent so many new infections, the researchers said, that its financial benefits would offset the large up-front investment needed for testing and treatment. "We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US $1.7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease," the authors wrote.

WHO AIDS chief Kevin De Cock plans to convene a panel of experts early in 2009 to discuss the study's implications. The authors made clear that neither they nor WHO is endorsing the strategy at present.

The report, "Universal Voluntary HIV Testing with Immediate Antiretroviral Therapy as a Strategy for Elimination of HIV Transmission: A Mathematical Model," was published in The Lancet (2008;doi:10.1016/S0140-6736(08)61697-9).
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