Amsterdam 2015
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| Abstract #2213 - Plenary | ||||
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Session: 57.2: Plenary (Plenary) on Friday @ 13.30-14.30 in C103 Chaired by Frans van den Boom, Bruno Spire, Bouko Bakker Authors: Presenting Author: Dr. Kenneth Mayer - Fenway Health/Harvard Medical School, United States |
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| Additional Authors: | ||||
| Aim: Animal models demonstrated that appropriate treatment can decrease retroviral concentrations in anogenital tissues, as well as in blood. Human observational studies found that the prompt initiation of antiretroviral treatment (ART) in HIV-infected individuals could decrease the likelihood of HIV transmission to uninfected partners. These findings were confirmed in HPTN 052, which compared early versus later initiation of ART for HIV-infected persons who had a primary HIV-uninfected partner. This result has led some to suggest that early initiation of ART could arrest HIV spread globally, an approach known as “Treatment as Prevention” (TasP).The durability of this effect, and its scalability in the real world, have been subsequently questioned. | ||||
| Method / Issue: A systematic review of the literature that could inform this discussion has been undertaken. Key studies and epidemiological data will be highlighted. | ||||
| Results / Comments: In response to the findings of HPTN 052 and other studies, in 2013, the WHO altered its criteria for when ART should be initiated, essentially recommending treatment of individuals who might be likely to transmit HIV to their partners as soon as they were diagnosed with HIV infection. This approach has been embraced in some regions (e.g. North America), but not others (e.g. Europe). Concerns about TasP have focused on the lack of data supporting the hypothesis that asymptomatic persons would be willing to initiate treatment to benefit their partners (“altruistic adherence”), as well as the potential costs and long term toxicities. Another concerns is that TasP could miss acutely infected persons, who may be source of many new HIV infections, while they are unaware that they are newly-infected. Others have raised concerns that TasP places all responsibility for HIV prevention on HIV-infected people. National surveillance data suggest that HIV incidence is decreasing in some countries, partially because of TasP, but incidence has not decreased in other settings, despite access to TasP. | ||||
| Discussion: TasP is a promising strategy to curtail HIV spread, but requires supportive environments so that HIV-infected feel safe about being diagnosed early in the course of their infection, and are motivated to initiate treatment without coercion, and are willing to adhere to ART, even when they are asymptomatic. | ||||
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