Published on June 15, 2011 by

Editorial: The wind is in our sails

The publication in May, with much fanfare, of the results of the HPTN 052 Randomised Control Trial of when to start HIV-positive people on ART was music to SACEMA’s ears. The trial involved HIV discordant couples. In the treatment arm, the HIV positive partner was started immediately on anti-retroviral therapy (ART); in the control arm, people were started on ART when their CD4 cell count fell below 250/µL, as currently advised by the World Health Organization. The study showed that early treatment cut transmission by 96% and the incidence of tuberculosis by 82%. Now that it is beyond dispute that treatment dramatically reduces individual infectiousness, the remaining concerns about Treatment as Prevention are operational, since we now need to determine how such large treatment programs be safely and effectively managed, and cost, since this would require a substantial up-front investment even though it will be cost-saving in the long run.