The HIV triple threat

On April 17, 2009, in HIV/AIDS, public opinion, by Karen Grepin

In an op-ed in the Washington Post today, Anthony Fauci clearly summarized what he sees as “three bold new approaches to controlling the HIV/AIDS pandemic“. I have heard all of the strategies he discussed to some degree here and there but thought it was good to see them all together. I also thought it was interesting to learn how seriously some of these “bold” strategies are being taken. The strategies are:

1. Pre-Exposure Prophylaxis (or PrEP): High risk individuals would be given a daily dosage of ARVs so that should they become exposed to the virus that the low dosage of medicine would prevent them from being infected. A version of this strategy is currently in use for people who become accidentally exposed to the virus, such a health workers.

2. Universal testing and treatment: basically test everyone and then treat everyone who tests positive. Mathematical modeling exercises have suggested that such a strategy could have a major impact on transmission.

3. Functional Cures: perhaps the least straightforward of the proposals but basically to come up with new treatment strategies that might make it more likely that the body would better control the disease. From my immunology days I remember a lot of people talking about really early treatment as a way to protect the immune system from ever getting depleted, this could be part of the strategy.

It is not clear how feasible any of these strategies would actually be, but it sounds like there is real interest in investing in research to learn more, which is always good news to me. Although he did not state it directly, but if we are considering such “bold” actions, it seems to be somewhat of an admission that current treatment strategies are not working, at least not if we are also trying to achieve population level goals.

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