TESTING everyone at risk of HIV and treating them with antiretroviral drugs could eradicate the global epidemic within 40 years, according to the scientist at the centre of a radical new approach to fighting AIDS. An aggressive programme of prescribing antiretroviral treatment (ART) to every person infected with HIV could stop all new infections in five years and eventually wipe out the epidemic, Brian Williams of the South African Centre for Epidemiological Modelling and Analysis told the American Association for the Advancement of Science. Williams is part of a growing body of experts who believe anti-HIV drugs are probably the best hope of preventing and even eliminating the spread of AIDS, rather than waiting for the development of an effective vaccine or relying solely on people changing their sexual lifestyle. The idea will be tested in the coming year, with the start of the first properly controlled clinical trial involving thousands of people living in Hlabisa in Somkhele, about 220km north of Durban. Williams said this would be followed by similar trials in the United States, where HIV is rampant in some inner-city communities. He said the immediate best hope was to use ART not only to save lives but also to reduce transmission of HIV. ART drugs could effectively stop transmission within five years, he said, adding that it might be possible to stop HIV transmission and halve AIDS-related TB within 10 years and eliminate both within 40 years. Antiretroviral drugs dramatically lower the concentration of HIV in a person's bloodstream, and, in addition to protecting patients against AIDS, they significantly lower an individual's infectiousness. Williams believes that, if enough infected people were treated, it would lower the rate of infection to such an extent that the epidemic would die out within the lifetime of those undergoing the treatment. He said the problem was that the drugs were being used to save lives, but not to stop transmission. Blocking transmission could only be done with an extensive testing regime followed by rapid treatment with antiretroviral drugs to everyone found to be HIV positive. Williams said the concentration of the virus dropped 10 000 times with ART, which probably translated into a 25-fold reduction in infectiousness. But if this was done, it would be enough essentially to stop transmission. A 2008 study showed it was possible to cut new HIV cases by 95 percent, from 20 per 1 000 to one per 1 000, within 10 years of implementing a programme of universal testing and prescription of ART drugs. The drugs have to be taken daily for life, and the cost for South Africa alone would be about $4bn (almost R30bn) a year. But the cost of having to treat a growing number of AIDS patients, as well as the economic cost of young adults dying off, would be higher than giving out free ART drugs to everyone who needed them.

Steve Connor: The Independent via The Cape Times, 23 February 2010