The HIV research and activist communities are counting down to the big AIDS conference in Melbourne (20-25 July 2014). One wonders if the ever greater buzz around ‘cure’, which has attracted so much attention in the last few years, will translate into the hot topic of AIDS 2014. This may be exciting basic science, and offer the (hardly imminent) promise of something better than decades of drug regimens for those infected, but it should not detract attention from the complex immediate situation still faced by much of sub Saharan Africa, and other countries, where access to cure is a very hypothetical lofty goal. This Quarterly discusses some of these immediate challenges.
In recent years, scientific innovations in HIV control have expanded the range of available interventions – male circumcision, topical microbicides, oral pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) have all sparked significant interest due to their potential effectiveness and versatility. While all these options are potentially available, resources remain limited and choosing which interventions to implement at scale is a difficult task, given the complex nature of disease transmission, the impact of behaviour in epidemic dynamics, and the different costs of these programs. Here we analyse the effects of scaling up PrEP and ART for HIV prevention in South Africa, to help decision makers understand how these interventions would work if considered independently or in combination.
Recently, antiretroviral drugs have been shown to dramatically reduce the risk of onward transmission from infected individuals (as ART) and also to reduce the risk of acquisition for uninfected individuals in stable relationships with infected partners (as Pre-Exposure Prophylaxis (PrEP)). This has raised many questions about how to harness these important findings for HIV prevention. Read More
The 6th IAS conference was held from 17-20 July 2011 in Rome. Although the conference is on HIV pathogenesis, treatment & prevention, the main focus this year was on the role of treatment in prevention. This prevention strategy can take different forms. First, by the immediate initiation of antiretroviral therapy (ART) after an HIV positive diagnosis, with a view to reducing a patient’s viral load and hence infectiousness. A second option is the use of a microbicide containing an antiretroviral, to reduce the probability of HIV negative people becoming infected. Finally, treatment as prevention can take the form of pre-exposure prophylaxis (PrEP) whereby antiretrovirals are used by individuals at high risk of exposure to HIV infection. The interim results of the FEM-PrEP trial showed that Truvada does not have a protective effect in women. But at the IAS conference the results of two new studies (the Partners PrEP trial and the TDF2 trial) on the use of oral PrEP in heterosexual people were extensively discussed. For these trials it was estimated that PrEP reduced the risk of transmission by between 62 and 78%.
The focus of this paper is to evaluate PrEP alongside ART and condom-use interventions in South Africa, informed by national HIV and demographical surveys. The age-structured model we developed pays close attention to the distribution of relative infection risks between age categories. It includes dynamical effects usually not explicitly modelled, such as age-dependent condom use and partner choice. Despite some the limitations of the model, the model offers a relatively simple approach to studying the impact of PrEP in the context of national and generalized HIV epidemics. The inclusion of an age variable offers a direct way of studying age-structured prioritising strategies.
The Conference on Retroviruses and Opportunistic Infections (CROI) is one of the biggest events on the HIV related calendar. One of the hot topics was ‘Pre-Exposure Prophylaxis’ (PrEP). However, questions remain about how this strategy, which provides antiretroviral treatment to HIV negative people – really fits into a world in which the majority of HIV infected persons lack access to treatment. Some other highlights of CROI are also discussed. Although HIV/AIDS dominates the agenda in local epidemiology, SACEMA is not an HIV research organization, and we are pleased to present three articles on very different topics: perioperative cardiovascular disease; a methodological perspective involving carcass surveillance; and an item on how medical research can fail so impressively. We trust you will find something of interest in this edition.