AIDS Drugs Should Be Used to Help Prevent Infections, WHO Says

By Simeon Bennett

Nov. 5 (Bloomberg) -- AIDS drugs should be given to all who need them to reduce new infections, the World Health Organization said, taking the view that the same weapons can serve for treatment and prevention.

Providing more antiretroviral drugs “will achieve a significant transmission benefit,” Teguest Guerma, interim director of the WHO’s AIDS department, said in a telephone interview today after a three-day meeting.

“In the past, there has been a false dichotomy between prevention and treatment,” Guerma said. “That is really what has been corrected. Prevention and treatment are two faces of the same coin.”

The meeting comes after a study last year suggested the spread of HIV in hard-hit African nations could be cut by 95 percent in a decade if everyone was tested and those found to be infected were treated immediately. Those projections were questioned last week by another study that said it was based on flawed assumptions. More research is needed, the WHO said.

About 2.7 million people were newly infected with HIV in 2007, and 2 million died of AIDS, according to the WHO, making it the world’s deadliest infectious disease.

Combinations of drugs, such as Bristol-Myers Squibb Co.’s Sustiva along with Gilead Sciences Inc.’s Truvada, can keep viral levels so low that HIV is undetectable by conventional means. That limits the patient’s ability to spread the disease.

‘Test and Treat’

The so-called “test and treat” strategy may involve millions more people getting treatment in nations already struggling to get drugs to those who need them. At least 5 million people with HIV in poorer nations don’t have access to the medicines out of 9 million who need them, the WHO said in a Sept. 30 report.

The study published last year in The Lancet suggesting a 95 percent cut in transmission was based on unrealistic assumptions that everyone would be tested annually and all those infected would be treated, researchers from the University of California Los Angeles said in the online journal Nature Precedings last week. If 65 percent of those with symptoms and 20 percent of those without were tested, elimination would be possible theoretically in 70 years, the researchers said.

“Even under optimistic assumptions we find elimination to be unlikely,” Sally Blower and Bradley Wagner said in their paper. “Achieving a very high treatment rate would reduce transmission substantially, but not enough to achieve elimination.”

The approach may also cause some people to take greater sexual risks because they see the drugs as a safety net, said Daniel Halperin, a lecturer on global health at Harvard University.

“I worry a little that the whole notion of treatment for prevention, while totally well-meaning, might further enhance this sense of drugs having overcome the epidemic,” Halperin said in an e-mail. “That might make it even more difficult to encourage behavior change and other prevention approaches.”

To contact the reporter on this story: Simeon Bennett in Singapore at sbennett9@bloomberg.net

Last Updated: November 5, 2009 09:57 EST

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