One of the pioneers of AIDS research, former Harvard retrovirology professor William Haseltine, said today that universal testing and treatment now offers the best hope of controlling the HIV pandemic.
Writing in the news magazine The Atlantic, Haseltine said that three other authorities involved in the discovery of HIV – Robert Gallo, Max Essex and Robert Redfield – have reached the same conclusion.
“History has shown that epidemics can be controlled, even in the absence of a vaccine,” he says. “Both syphilis and tuberculosis were pandemic at the end of the nineteenth century, and both epidemics were controlled by effective diagnosis and treatment.”
“I recommend that WHO, PEPFAR and the Global Fund begin studies to assess the effectiveness of universal testing and early treatment for the prevention of HIV transmission,” he urges.
At a recent seminar on global governance challenges at the James Martin 21st Century School at Oxford University, Professor Jonathan Weber of London’s Imperial College said that after 27 years in HIV research, he no longer believes a vaccine to be achievable. Instead he believes that population-based antiretroviral therapy (PopART) is the only strategy currently available that holds out the prospect of HIV eradication.
Population-based treatment, or universal testing and treatment, is a subject of growing interest to researchers. Last November the World Health Organization published details of a mathematical modelling exercise which suggested that if all people in South Africa could be diagnosed and begin antiretroviral treatment within a year of infection, the incidence of new infections could be reduced by 95% within ten years, assuming that treatment reduces the risk of transmission by 99%.
At the Sixteenth Conference on Retroviruses and Opportunistic Infections earlier this month, two studies of transmission risk in HIV-discordant couples were presented. One showed no cases of transmission in couples where the HIV-positive partner took antiretrovirals, while the other showed an 80% reduction in transmission risk.
Christophe Fraser, an epidemiologist from Imperial College, London, warned the confererence that the striking effect of universal treatment in mathematical models might not be replicated in real life if it proved less than 99% effective, and called for careful examination of the assumptions in the WHO models by other epidemiologists before policy is made.