International
AIDS Society and WHO Urge Universal Access to HIV Therapy
for Prevention as Well as for Treatment
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| SUMMARY:
Health Organization (WHO) last week affirmed
that universal access to antiretroviral
therapy (ART) should be made available in
order to both treat HIV/AIDS and to prevent
transmission of the virus worldwide. The
International AIDS Society (IAS) applauded
this step and called for immediate funding
and action to expand ART access. Numerous
studies have shown that people who are on
ART that suppresses viral load to an undetectable
level are dramatically less likely to transmit
HIV to others. |
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Following
is the text of the recent announcement from the IAS.
IAS
Urges New Focus on ART As Prevention, Calls
for Immediate Global Action and Funding for
Universal access to HIV Therapy
 November
4, 2009 -- Geneva, Switzerland -- The International
AIDS Society (IAS) today saluted the World
Health Organization (WHO) for its focus on
scaling up antiretroviral therapy (ART) as
prevention as well as for treatment. The WHO
consultation that concluded today has reaffirmed
the urgent need for universal access to ART
for the treatment of people living with HIV,
emphasizing the clinical benefit of early
treatment for individuals, as well as the
prevention impact of increased access to ART
in reducing HIV transmission and tuberculosis
(TB) incidence. The IAS's statement came at
the end of a three-day consultation on ART
for HIV Prevention convened by WHO.
ART significantly reduces HIV viral load,
thereby reducing the risk of HIV transmission.
In high-income countries, ART has virtually
eliminated transmission of HIV from mothers
to their babies, and a number of studies indicate
that universal provision of ART to people
living with HIV would have a major impact
on reducing HIV transmission and TB incidence
globally.
A recent mathematical model by Granich et
al (WHO, 2009) also has proposed that universal,
voluntary HIV testing on an annual basis,
immediately followed by ART for all persons
who test positive, would likely result in
a 95 percent reduction in annual HIV incidence
globally within 10 years.
Importantly, the health benefits of universal
access to ART are not limited to reducing
HIV illness and transmission. Earlier initiation
of ART has also been associated with better
survival, improved tolerability of therapy,
and improved immune response, and has been
shown to reduce the transmission of tuberculosis
among HIV-infected individuals.
"In addition to saving lives and improving
individual health, HIV therapy has tremendous
potential to improve health at the community
level, by reducing HIV transmission and the
incidence of tuberculosis, which continues
to be a major killer in low- and middle-income
countries" said IAS President Dr. Julio
Montaner, Director of the British Columbia
Centre for Excellence in Vancouver, Canada.
"But the promise of ART, to save lives
and reduce millions of new HIV infections,
will not be fulfilled without immediate follow-through
on the commitment to universal access made
by the G8 nations in 2005. That commitment
comes due in 2010, and we are still far from
able to reach all those in need of therapy
quickly and effectively."
The UN's most recent progress report on universal
access indicates that less than half of all
people living with HIV in the world who could
benefit clinically from ART have access.
WHO treatment guidelines call for the initiation
of ART at a relatively late stage of HIV disease,
when an individual's immune system has already
been weakened substantially by the virus.
These guidelines will change soon, and new
guidance is expected to urge earlier initiation
of ART.
Noting that demand for ART access, and associated
costs, will increase significantly as programs
adopt the clinically sound CD4 threshold of
350 cells/mm3 as a starting point for ART,
Montaner added that "savings from reduced
HIV transmission, increased well being, and
decreased illnesses and hospitalizations make
such a move not only feasible but also fiscally
sound. Our models suggest that this can be
a highly cost-effective strategy."
The IAS specifically called for increased
operations research on the preventative benefits
of more widespread treatment scale up, including
continued support for the 2007 Sydney Declaration,
which was adopted at the 4th IAS Conference
on HIV Pathogenesis, Treatment and Prevention.
The declaration urges that 10 percent of all
resources dedicated to HIV programming from
granting agencies and national health budgets
be allocated for operations research to improve
HIV interventions.
"At every step along the way to universal
access, the scale-up of HIV treatment should
be guided by operations research," said
IAS Executive Director Robin Gorna. "Such
research will ensure that the implications
of more widespread HIV testing and treatment
-- including its implications for equity,
human rights, morbidity and mortality, and
the preventative impact of ART on HIV transmission
-- are informed by evidence of what works
best."
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