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International AIDS Conference – Day 4

There's a mantra in the AIDS world: Treatment is prevention.

This isn't a new idea, but it's gaining a lot more traction, particularly in light of the desperate need for new prevention approaches. Just consider the numbers: For every two people with HIV who get antiretroviral (ARV) drugs, there are five others who are newly infected. So how to stop the cycle?

Some see treatment as the answer. It is known ARVs can decrease the amount of virus in the body to undetectable levels. And the lower the virus, the less the risk of HIV transmission. Therefore, if it were possible to identify and treat all people with HIV, the virus would simply wither away.

"If you wait long enough, HIV infection will disappear," though it could take decades, Swiss researcher Bernard Hirschel, MD, said today at the International AIDS Conference.

During almost 30 years of the epidemic, he noted, there's been little new in the way of prevention. There are condoms, but these are not entirely effective, given the nature of human behavior. And circumcision has limited applicability. But if you treat all the infected people in the community early, you could provide widespread protection against HIV. Or so the theory goes.

Several studies support the idea. One, conducted by the University of Washington and financed by the Bill & Melinda Gates Foundation, looked at 3,400 heterosexual couples in seven countries in sub-Saharan Africa. In each couple, one partner was HIV-positive, while the other was HIV-negative. When the HIV-positive partner was treated, the HIV transmission rate was 92 percent lower than among couples where the positive partner did not receive treatment. A similar study among 476 couples in Madrid produced similar results, Hirschel said.

But there are a lot of caveats to this approach, and more studies are needed, he said. He is launching a major, $3 million Euro trial in South Africa, together with the African Center for Health and Population Studies. The goal is to screen everyone in the community for HIV and provide treatment to all those found to be positive. Community-wide protection could be a "pipe dream," Hirschel said. But at least he wants to find out.

Ruthann Richter is a Scope contributor and writer in the medical school's communication office. She is attending the International AIDS Conference in Vienna and is posting periodic updates on the happenings there. You can see all of her updates in our HIV/AIDS category.

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