Providing antiretroviral therapy to everyone in the world infected with HIV would stop the HIV epidemic in its tracks within 50 years at an average cost of $7 billion a year, according to mathematical modelling carried out by the British Columbia Centre for Excellence in HIV/AIDS, published today in The Lancet.
The researchers say that their model assumes little or no transmission would occur from people on antiretroviral treatment, based on findings from Uganda, Spain and Taiwan.
The model also assumes that instead of treating only those with low CD4 cell counts, all HIV-positive people would receive treatment from the time of diagnosis, and that treatment would cost $365 a year, rising by 3% a year.
The authors, led by Professor Julio Montaner, say their model shows that HIV prevalence could be reduced 70-fold, from 7 cases per 1000 people to 0.1 case per 1000 by 2050.
In the early years treatment would cost more than $15 billion a year, but this cost would decline as the numbers of newly infected individuals shrank.
The model doesn’t include any costs for the wider health care system, such as monitoring, health care workers and testing kits.
The authors say that “the status quo is no longer acceptable if we hope to control the continued growth of the HIV global pandemic.” They note that in 2005, twice as many people became infected as started treatment worldwide.
They urge their model to be tested widely by incorporating monitoring of HIV incidence into all treatment programmes.
In Uganda, where the US Centers for Disease Control looked at HIV incidence among the partners of people receiving antiretroviral therapy through a home-based care programme, only one person contracted HIV out of a group of 454 people in the first year of treatment.
However, the British Columbia study reported today does not take into account the effect of additional interventions. In the Ugandan study, strong attempts were made to encourage partners to learn their HIV status by going door to door and offering the test. Couples were counselled together about risk reduction, and treatment was provided for sexually transmitted infections. All these factors may have contributed to the huge reduction in transmission too.
Montaner JSG et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. The Lancet 368: 531-536, 2006.