The World Health Organization has suggested that universal voluntary HIV testing followed by immediate treatment in positive cases would significantly reduce HIV cases globally, according to an article published online in The Lancet.
A team of researchers from WHO used computer modelling to show that universal voluntary HIV testing, combined with immediate antiretroviral treatment (ART) following positive diagnosis, would reduce HIV cases in a severe generalised epidemic from 20 per 1,000 people to 1 per 1,000 people within 10 years.
Adopting such a strategy, therefore, could reduce HIV cases by 95%, says the article written by Dr Reuben Granich, Department of HIV/AIDS, WHO, Geneva, Switzerland and colleagues.
The approach could cut the number of new infections, because people knowing that they have AIDS sooner could encourage safer sex practices and drugs lower the levels of virus in the body and thus make HIV transmission through unprotected sex much less likely.
Around three million people worldwide had received ART by the end of 2007, but an estimated 6.7 million were still in need of treatment and a further 2.7 million became infected in 2007.
The authors used mathematical modelling to explore the effect on the case reproduction number and long-term dynamics of the HIV epidemic of testing all people in their test community (aged 15 years or over) for HIV every year and starting HIV antiretroviral treatment immediately after a positive diagnosis.
They used data from South Africa – the country with the highest rate of HIV – as a test case for a generalised epidemic, and the model assumed all HIV transmission was heterosexual.
They found the strategy could greatly accelerate the transition from the current endemic phase, in which most adults with HIV are not receiving ART, to an elimination phase, in which most adults are on ART within five years.
The authors say: “Instead of dealing with the constant pressure of newly infected people, mortality could decrease rapidly and the epidemic could begin to resemble a concentrated epidemic with particular populations remaining at risk.
“The focus of control would switch from making ART available to people with greatest need to providing support and services for those who are receiving ART. Transmission could be reduced to low levels and the epidemic could go into a steady decrease towards elimination.”
The strategy, however, raised some human rights issues as currently people who are HIV positive are not put on treatment until they need it, because of the toxicity and side-effects of ART drugs.
In an accompanying comment, Professor Geoffrey Garnett, Imperial College London, UK, says: “The suggested strategy would reflect public health at its best and its worst.
“At its best, the strategy would prevent morbidity and mortality for the population, both through better treatment of the individual and reduced spread of HIV. At its worst, the strategy will involve over-testing, over-treatment, side-effects, resistance, and potentially reduced autonomy of the individual in their choices of care.”
DOI:10.1016/S0140-6736(08)61697-9