What if everyone with HIV were put on meds, not necessarily to protect their own health but to reduce the risk of spreading the virus to others? Researchers at the University of British Columbia (UBC) are making that radical proposal and fielding some tough questions.
“Even really motivated patients have difficulty with adherence,” says New York City HIV specialist Lloyd Bailey, MD, who wonders how he’d handle that problem with patients who don’t want to be on drugs in the first place—not to mention convincing them to tolerate the often difficult side effects. He fears a spike in drug resistance worldwide.
And how realistic is mass treatment? “We can’t even get condoms to people who want to use them to prevent HIV,” says Julie Davids of the New York-based advocacy group Community HIV/AIDS Mobilization Project (CHAMP). “How are we going to get them drugs?”
The UBC researchers—led by Julio Montaner, MD, who next week begins his term as president-elect of International AIDS Society at the International AIDS Conference in Toronto—propose that doling out treatment even to those that don’t “need” it under current standards would cripple the disease by lowering their viral loads and, in turn, their ability to infect others. In 45 years, they say, the number of HIV positive people worldwide would drop from 38 million to just one million.
Dr. Montaner told POZ that "there’s a continuous push back and forth [now] between prevention and treatment, and I think the time has come to move beyond that and recognize that prevention and treatment now synergize to reduce HIV transmission."
He also believes that it’s a better way to spend money in the long run. “Our exercise suggests that while antiretroviral therapy is highly cost effective on a patient-centered basis, it can also afford you twice as much savings if you look at what it can do in decreasing transmission of HIV.”
Dr. Bailey is among many who consider Dr. Montaner’s idea worthy of discussion but fear for the needs and rights of individual patients. They’re waiting to hear more when Dr. Montaner delivers a speech on the subject next Wednesday, August 16th in Toronto.
“I think that it merits testing in a formal fashion,” agrees Shaffiq Essajee, MD, a pediatrician who spends several months a year treating HIV positive children at a clinic in Mombasa, Kenya, and is senior adviser in pediatrics at the Clinton Foundation’s HIV/AIDS Initiative.
However, with only about 17% of sub-Saharan Africans having access to the HIV treatment they need, “Clinics are already full to overflowing,” says Dr. Essajee. And even in the U.S., he asks, “What sort of capacity is there to absorb that many folks on treatment?”
