As the world embraces immediate treatment for HIV, the game is not over: stigma and discrimination persist; drug procurement, supply and delivery are failing in many countries; ways must be found to ensure adherence with treatment to keep people alive, minimize resistance and stop transmission; thirty million people will need treatment for the next half-century or until a cure is found. This is an auspicious time to review a few of the many studies that have accumulated over the last fifteen years in support of providing treatment for people infected with HIV as early and as soon as possible
The relationship between narrative and paradigmatic thinking in science, at least in the world of natural philosophy and natural history, is crucial and yet seldom explicitly stated and rarely understood. Creativity in science lies primarily in the narrative mode of thinking and it is here that new discoveries are made and new ideas are found. While we should find ways to develop narrative thinking when teaching science we must also ensure that our students develop the necessary skills to manipulate the paradigmatic formulations of their theories.
UNAIDS has reported that the prevalence of people infected with HIV but who are not on ART, the incidence of HIV, and AIDS related mortality are falling. The Health Metrics Institute recently made their own, semi-independent, assessment of the trends in each of these indicators and reached similar conclusions with small differences arising from the use of somewhat different assumptions. Both analyses suggest that the world is on track to end AIDS by 2030, but this will depend on continued expansion of treatment at about the present rate together with supportive prevention efforts in Sub-Saharan Africa. Unfortunately, the data on which these analyses are based is weak in almost all places and better data on patient monitoring, follow-up and support, including drug procurement, supply and delivery, and better routing surveillance are needed.
King James VI of Scotland, I of England, (1567−1625) commissioned the most influential book ever to be written in English. While the language of the King James Bible has done much to define modern English, it can be argued that the Bible also developed, for the first time, the notion of peer-review which is at the very heart of modern science. And one may argue further that the way in which he organized the writing of the new Bible holds lessons for how we should organize our scientific lives today.
Currently we are faced with two major threats from viral diseases: Over the last 30 years HIV has spread across the world and continues to plague us. Over the last 3 months the hemorrhagic fever caused by the Ebola virus has spread across West Africa killing thousands of people. If we are to contain HIV in the long-run and Ebola, hopefully, in a much shorter time, this will depend on our ability to understand the nature of the threat and the strategies of the disease causing organisms.
At the 3rd International HIV Treatment as Prevention Workshop in Vancouver, Canada, in April 2013 I was asked to put forward the case that “Pre-Exposure Prophylaxis (PreP) is not an essential component of Treatment as Prevention (TasP)”. So my job was to convince the public that while PreP may be a useful, and even an important, addition to TasP it is by no means an essential component of TasP. Here I reproduce my argument and invite readers of the SACEMA Quarterly to express their own views on this important issue.
Scientists at SACEMA have been in the forefront of those arguing that the time to end AIDS is now and the way to do this is through the strategic use of potent anti-retroviral therapy (ART). The road ahead will be long and hard and much still needs to be done. If we are to increase the number of people in the world who are on ART from the present 5 million to 15 million by, say, 2015 and to 30 million by 2020, many operational challenges will have to be understood and met. Here we outline the most important issues that need to be explored if treatment-as-prevention is to become a reality and if we are to end AIDS.
Behaviour change interventions have not brought about a sufficient reduction in HIV transmission. The question is whether anti-retroviral therapy (ART), used to effectively treat HIV patients, could also be used to stop transmission. This article discusses whether treatment-as-prevention is feasible, by determining the extent to which ART reduces the infectiousness of HIV-positive people. Furthermore, it looks at whether this is a realistic approach, by considering the levels of acceptance and compliance that might be achieved, the cost of the drugs, the rate of development of resistance, drug delivery and patient management.
The Lancet recently reported that universal HIV testing and immediate antiretroviral therapy (ART) for everyone diagnosed with HIV in countries such as South Africa could reduce new infections by 95% within ten years. This article describes the benefits and objections (costs, human resources, side effects, drug resistance) to the idea of starting all HIV positives on ART in South Africa, including the way forward.