HIV Prevention: For Test and Treat, the Time is Now

A little over a year ago, I described studies in Botswana that raised the possibility that the HIV/AIDS epidemic might be controlled by a test and treat regime, a program in which all those with HIV infection were treated with combination chemotherapy as soon as the infection was detected. The program also calls for more extensive HIV testing to identify as many people infected with the virus as possible.

A recent study published in The Lancet, a medical journal, demonstrates that early treatment can reduce HIV heterosexual transmission of HIV tenfold or more. More than 3,300 Nigerian couples in which only one partner was infected were observed for two years. Infection of the uninfected partner was reduced up to 12 times less likely if the infected partner was treated early, regardless of his health status or CD4 cell count. Today international guidelines call for initiation of treatment when the CD4 cell count falls either below 350 or 250 (normal levels are between 500-1,000 cells).

The study also provides an explanation of the results. Most transmissions to the uninfected partner occurred when the virus load (the number of virus particles measured in one milliliter of blood) was 50,000 or greater. Treatment with anti retroviral drugs reduces the viral load tenfold or more.

An accompanying editorial by an international team of HIV/AIDS specialists, "HIV Drugs for Treatment, and for Prevention," calls for rapid implementation of a treatment as a prevention strategy, abandoning the current practice of treating only those with advanced disease. In the absence of a vaccine, test and treat holds the greatest promise of stemming this deadly pandemic. I urge widespread implementation of test and treat programs in the United States (Washington DC, Baltimore, Miami as well as in South Africa, Nigeria and other hotspots of the HIV/AIDS epidemic). Vigorous action now may finally slow and stop this tragic epidemic.