The Lancet and AIDS: wishful thinking or viable strategy?

[Darth Rotor]

http://www.msnbc.msn.com/id/27911541/?gt1=43001

The research was published online Tuesday in the medical journal The Lancet.

Do any of you read the Lancet regularly? I didn't find a quick link, and don't subscribe.

LONDON - The virus that causes AIDS could theoretically be eliminated in a decade if all people living in countries with high infection rates are regularly tested and treated, according to a new mathematical model.

It is an intriguing solution to end the AIDS epidemic. But it is based on assumptions rather than data, and is riddled with logistical problems.

Gilks and colleagues used data from South Africa and Malawi. In their model, people were voluntarily tested each year and immediately given drugs if they tested positive for HIV, regardless of whether they were sick.

Within 10 years, HIV infections dropped by 95 percent. Other initiatives like safe sex education and male circumcision were also used. The strategy would cut the estimated number of AIDS deaths between 2008 and 2050 by about half, from about 8.7 million to 3.9 million, leaving only sporadic HIV cases.

The cost cited was about 3.4 billion a year. For ten years. If a globally resourced initiative were undertaken, my guess is that level of funding might be achievable. Troubling: from the short summary, some significant behavioral issues are non trivial obstacles. I'd like to see the Lancet article, but maybe it has to gestate a day or two to crop up on the internet for non subscribers.

I admit I laughed at how they juxtaposed the bolded words, which tempted me to link to our previous multi-page discussion on circumcision and AIDS.

One here http://www.internationalskeptics.com/forums/showthread.php?t=75534 This one is more focused on the AIDS/circumcision issue.

One here http://www.internationalskeptics.com/forums/showthread.php?t=116423&highlight=Circumcision

DR

 

[Skeptic Ginger]

You could also eliminate TB in humans if you treated everyone with very inexpensive drugs but it will not happen under current conditions. Two things are in the way. Poor countries do not have the public health infrastructure to administer such programs and a fair proportion of the infected individuals are street people, drug addicts and the mentally ill. In that reservoir are people you could not maintain on a treatment program unless you incarcerate them for the duration.

I'll see if I can access the article but I only get some Lancet articles free online. The rest I can get at the library but only in person. Maybe one of our forum physicians has access?

 

[Skeptic Ginger]

Here's the abstract, the full article is pay per view:

Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model

Background
Roughly 3 million people worldwide were receiving antiretroviral therapy (ART) at the end of 2007, but an estimated 6·7 million were still in need of treatment and a further 2·7 million became infected with HIV in 2007. Prevention efforts might reduce HIV incidence but are unlikely to eliminate this disease. We investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination.
Methods
We used mathematical models to explore the effect on the case reproduction number (stochastic model) and long-term dynamics of the HIV epidemic (deterministic transmission model) of testing all people in our test-case community (aged 15 years and older) for HIV every year and starting people on ART immediately after they are diagnosed HIV positive. We used data from South Africa as the test case for a generalised epidemic, and assumed that all HIV transmission was heterosexual.
Findings
The studied strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within 5 years. It could reduce HIV incidence and mortality to less than one case per 1000 people per year by 2016, or within 10 years of full implementation of the strategy, and reduce the prevalence of HIV to less than 1% within 50 years. We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US$1·7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease.
Interpretation
Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics. This approach merits further mathematical modelling, research, and broad consultation.

 

[Darth Rotor]

Here's the abstract, the full article is pay per view:

Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model

I wonder at the point of this assumption:

We used data from South Africa as the test case for a generalised epidemic, and assumed that all HIV transmission was heterosexual.

Assuming away one of the various transmission paths seems a less than rigorous assumption.


DR

 

[Capsid]

I wonder at the point of this assumption:

Assuming away one of the various transmission paths seems a less than rigorous assumption.


DR

Are you assuming heterosexuals don't engage in anal sex?

 

[casebro]

So what's the news here? That AIDS drugs work?

 

[Capsid]

So what's the news here? That AIDS drugs work?

The news is that knowing the drugs work so well then their use should be expanded to all HIV infected people that are identified by regular testing. This would then reduce/eliminate their infectivity.

 

[AWPrime]

Or just cause the HIV to mutate, considering that many of those people won't take their meds properly.