Today is the twentieth annual World AIDS Day, and on this anniversary many eyes have turned to a controversial new study modeling a virtual end to the virus in about 10 years. Whether the study truly points the way to an end to the epidemic, it shows the ambitious goals of a research community that has not given up the fight.
Recent research has focused on the importance of delivering antiretroviral medications to people with HIV shortly after diagnosis, rather than waiting until immune symptoms appear, as was previously advised. And, there is emerging research indicating that current antiretroviral therapies can keep levels of the virus so low in the bloodstream that transmission rates are effectively suppressed. Now, a study in the British journal The Lancet conducted by the World Health Organization's AIDS treatment expert Charlie Gilks and colleagues indicates a combination of testing all adults annually for HIV and immediately beginning antiretroviral therapies on all infected persons could virtually eliminate HIV in Africa in 10 years.
The study uses a model based on data from South Africa and Malawi, and projects the outcome if people were tested every year and given treatment even if they were not sick. The results indicated a 95 percent reduction in incidence of HIV in ten years. The authors project that deaths from AIDS would fall by roughly half, from about 8.7 million to 3.9 million. Still, the study is a set of projections based on a limited model: it assumed that only heterosexual sex contributed to transmission; that people would voluntarily submit to testing; and that they would also willingly start treatment. None of these is likely to be universal in a real-world setting, as critics of the study have pointed out. Similarly, the risk of increased drug resistance with such wide use of antiretroviral therapies, and the fact that no none yet knows how people will fare with multiple decades on such treatment, are also limiting concerns. In fact, according to the AP/Google.com, this "intriguing solution" to ending the HIV/AIDS epidemic is "based on assumptions rather than data and is riddled with logistical problems."
Still, the study's authors see no reason not to think big. Only three million people worldwide are on antiretroviral therapies, of the roughly 33 million people who have HIV. To construct a world in which all of those people received treatment, and the epidemic halted, is a radical vision. "It's quite a startling result," said Charlie Gilks. "In a relatively short amount of time, we could potentially knock the epidemic on its head." On this World AIDS Day, that is a goal all of us would like to embrace.