In a Comment in this week's HIV special issue of The Lancet, Dr Julio Montaner (British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada) says that treating people with HIV with highly-active antiretroviral drugs (HAART) as a means for preventing onward transmission, in addition to preventing HIV related morbidity and mortality, "has progressed from a testable hypothesis to an urgent implementation priority."
The Treatment as Prevention strategy advocates for widespread availability of voluntary HIV testing and easier access to free HIV treatment for all medically eligible HIV-positive individuals. Current HIV treatment reduces the level of HIV in the blood to undetectable levels, thus improving the health of HIV-positive individuals, and preventing HIV related morbidity and mortality. At the same time, the treatment decreases the level of HIV in sexual fluids to undetectable levels, thereby reducing the likelihood of HIV transmission by over 96%, as demonstrated by the recently reported HPTN 052 study.
Dr Montaner says: "For the past decade, we have struggled with the substantial tension between those advocating for the need to rigorously pursue every question before implementing treatment as prevention initiatives and those advocating for the research to be done as part of an implementation strategy."
He adds that the evidence is now clear that HAART conclusively prevents morbidity, mortality, and transmission, and that these three endpoints should be considered together in treatment strategies from now on. New guidelines that fully incorporate treatment as prevention, are now urgently required, with Montaner adding "it would be unethical not to offer immediate HAART to couples in which one partner has HIV and the other does not".
Dr Montaner concludes: "The evidence is in: treatment is prevention. Treatment dramatically prevents morbidity and mortality, HIV transmission, and tuberculosis. Furthermore, treatment prevents HIV transmission in vertical, sexual, and injection drug use settings; indeed, a very welcome double hat-trick. The challenge remains to optimise the impact of this valuable intervention. Failure to do so is not an option."
To interview Dr Julio Montaner, please contact: Mahafrine Petigara, Edelman, T) +1 604-623-3007 ext. 297 E) mahafrine.petigara@edelman.com