Universal and annual voluntary testing followed by immediate antiretroviral therapy treatment (irrespective of clinical stage or CD4 count) can reduce new HIV cases by 95% within 10 years, according to new findings based on a mathematical model developed by a group of HIV specialists in WHO.
Authors of the study also report that the universal voluntary testing followed by immediate ART could have additional public health benefits, including reducing the incidence of tuberculosis and the transmission of HIV from mother to child. Additionally, the model suggests that there could be a significant reduction of HIV-related morbidity and mortality in resource-limited countries with generalized HIV epidemics.
The current WHO policy on treatment involves voluntary testing and clinical and/or immunological evaluation (e.g. CD4 count) to determine eligibility for treatment with antiretrovirals.
The authors emphasize the theoretical nature of the exercise based on data and raise a number of concerns regarding feasibility, including the protection of individual rights, drug resistance, toxicity and financing challenges.
The paper does not signal a change in WHO guidance. WHO-recommended preventive interventions need to be maintained and expanded. This includes male circumcision, partner reduction, correct and consistent use of condoms, and interventions targeting most-at-risk populations, also known as "combination prevention."
WHO will convene a meeting early next year bringing together ethicists, funders, human rights advocates, clinicians, prevention experts and AIDS programme managers to discuss this and other issues related to the wider use of antiretroviral therapy for HIV prevention.
- Granich et al. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. The Lancet, November 26, 2008; DOI: 10.1016/S0140-6736(08)61697-9
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