Page last updated at 06:00 GMT, Wednesday, 27 May 2009 07:00 UK

HIV drugs 'could stop virus spread'

Michael Carter
VIEWPOINT
Michael Carter
Editor for NAM, theHIV/Aids information charity

HIV drugs
Taking HIV drugs could stop the virus spread as well as controlling illness

The main focus for HIV prevention work is still encouraging people to use condoms.

But in this week's Scrubbing Up health column, HIV expert Michael Carter says increasing the numbers taking medication would reduce infections to the same degree.

Over the last 15 years, HIV treatment has transformed the outlook of people with the virus.

Modern HIV treatment is now so good many with the virus will be able to live a normal lifespan.

But HIV treatment also has another desirable outcome - the people who take it are less infectious.

Indeed, the impact of HIV treatment on infectiousness is so great that it might have the potential to stop the epidemic in its tracks if everyone took an HIV test each year and everyone diagnosed with HIV received treatment.

'Zero risk'

The currently available treatment cannot cure a person of HIV.

Instead, taking a combination of three different drugs every day can reduce levels of HIV in the blood to undetectable levels.

Because there is hardly any HIV around, the immune system can stay strong and fight infections.

Treatment not only works against virus in the blood, it also lowers the amount of virus in genital fluids, and this has a huge impact on an individual's infectiousness.

Taking long-term HIV treatment to help control the epidemic is realistic

Indeed, some doctors believe that in certain circumstances people taking HIV treatment pose a zero risk of infection to their sex partners.

In January 2008 some senior HIV doctors in Switzerland issued a statement that said that people who've been taking HIV treatment for at least six months, who take their treatment properly, and who don't have any sexually transmitted infections, are never infectious to their monogamous heterosexual partner.

Evidence supporting what's become known as the Swiss Statement comes from studies that showed that there were no HIV transmissions in heterosexual couples when the amount of virus in the blood fell below a certain level.

No replacement

There is a general consensus that anti-HIV drugs can dramatically reduce the risk of HIV transmission.

Just how dramatic the impact of treatment on infectiousness actually is has been hotly debated.

It's been pointed out that there are apparent cases of HIV transmission when a person is taking HIV treatment, despite having undetectable levels of the virus.

However, these are few and far between (although that's likely to be little comfort for the individuals involved).

Overall, HIV treatment resulting in undetectable levels of the virus in the blood is thought to reduce the risk of HIV transmission to the same extent as correct and consistent condom use.

Condoms
Condoms are "still crucial" to preventing the spread of HIV

That doesn't mean that it is a replacement for condoms or other methods of HIV prevention.

Condoms remain central to the control of the epidemic, not least because sexually transmitted infections can increase the amount of HIV in genital fluids, meaning a person is more infectious.

There is real hope that HIV treatment can make a difference to the spread of the epidemic.

Increasing the number of people on treatment is being advocated as an HIV prevention method in the Canadian province of British Columbia.

Getting more people to test for HIV and start treatment at the right time could have a big impact on the number of new infections in the UK, which are among the highest in Europe.

Modern HIV treatment is powerful, can consist of just one pill once-daily, and often causes only mild side-effects.

Taking long-term HIV treatment to help control the epidemic is therefore realistic.

HIV nevertheless remains an extremely serious, life-affecting and potentially life-limiting infection.

Recognising the potential of HIV treatment to prevent infections could slow, even halt the epidemic, and spare people the physical and mental suffering that the infection all too often entails.

It's worth giving it a try.




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