Short item Published on November 30, 2010

Treatment as prevention: the discussion continues

In the first edition of the SACEMA Quarterly (March 2009) Brian Williams provided a discussion on the various arguments for and against the in a Lancet article suggested approach of ‘treatment as prevention’ of HIV (early treatment of HIV infected individuals will prevent transmission of the virus) (1). As this ‘test-and-treat’ strategy continues to be the topic of – often heated – debate, another article was devoted to this issue, focusing on how feasible and realistic this approach is (2). Recently a letter has been published in the Lancet, indicating that the costs of eliminating HIV in South Africa have been underestimated (3). The appearance of this piece merely indicates that more research needs to be done on the cost-effectiveness of this approach. Keeping in mind that is very difficult to answer what the costs are for the society in terms of e.g. lives and productivity lost.

While the debate continues, there is also time to celebrate the achievements up till now: The AIDS scientist Dr. Julio Montaner has won the Albert Einstein World Award of Science for his pioneer wok on this life-saving concept of treatment as prevention (4). The British Colombia Centre for Excellence in HIV/AIDS, under the leadership of Dr. Montaner is currently implementing this strategy in a pilot project to Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS). As a direct result of this work, the province has already seen a decrease in new HIV diagnoses and a reduction in HIV related morbidity and mortality. Dr. Montaner aims to help prioritize treatment as prevention around the globe and bring vital life-saving therapies to the low- and middle-income countries where they are needed most urgently. Dr. Montaner is keen to work with SACEMA on developing a feasibility study in South Africa to test the idea of treatment as prevention and Dr. Viviane Dias Lima (who works closely with Dr. Montaner) will be coming to spend some time at SACEMA.