Study: HIV Could Be Eliminated In A Decade

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

"It's quite a startling result," said Charlie Gilks, an AIDS treatment expert at the World Health Organization and one of the paper's authors. "In a relatively short amount of time, we could potentially knock the epidemic on its head."

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.

Experts think the strategy's cost would peak at about $3.4 billion a year, though expenses would fall after an initial investment.

"This is certainly beyond the bounds of the current infrastructure for many countries, but that is not a reason not to think big," said Myron Cohen, of the University of North Carolina, who has done similar research. He was not involved in the WHO study.

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Only 3 million people are currently on AIDS drugs. Nearly 7 million people are still awaiting treatment, and about 3 million more people were infected last year. Worldwide, WHO guesses that about 33 million people have HIV.

Increasing access to testing and drugs would stretch already weak health systems in Africa, which has most of the world's HIV cases.

"This is not like giving someone a Tylenol," said Jennifer Kates, director of HIV policy for the Kaiser Family Foundation in Washington, DC. Once people start AIDS drugs, they must continue indefinitely. "The idea should be explored, but it's a huge leap," Kates said.

Handing out AIDS drugs to everyone who tests positive could also worsen drug resistance.

In addition, doctors don't know if it's safe to take AIDS drugs for decades; the oldest drug combinations have only been around for about a dozen years.

Other experts questioned whether the strategy might infringe on patient's rights. Once people test positive for HIV, they would be advised to start treatment, even if they weren't sick.

That would benefit the community, but not necessarily the patients themselves. AIDS drugs come with side effects including vomiting, liver failure, and heart attacks.

WHO emphasized that the study findings do not signal a policy change. "This is only a theoretical exercise," said Dr. Kevin De Cock, director of WHO's HIV/AIDS department. He said WHO would hold a meeting next year to study the idea more closely.

On the Net:

http://www.lancet.com

http://www.who.int

Comments

[Mnemanth]

"The money's not in the cure- the money's in the medicine!"- Chris Rock

[entropy2]

Naw, makes too much sense. Besides, ain't much profit to the Pharmas if you wipe out a disease.

[Dave01]

It would also be helpful if the Catholic Church would literally STOP telling people to not use condoms.

[PWM]

The Catholic Church, and right-wing churches in general, want people to suffer. Suffering is made a virtue. As Nietzsche pointed out Christianity creates suffering and has never removed one source of suffering ever.

[TruthAndTheory]

Yes! And Africa needs our assistance wholeheartedly. It's not our place to tell another country that we will only assist them if they abstain from sex and adhere to American rules. Condoms, condoms condoms. and a healthy dose of sex ed. Kids should not graduate from high school without knowing how to prevent disease.

[berrycooda]

It might be wiped out....

drug users quit sharing needles....

sex "users" start using protection....

infected mothers stop getting pregnant and giving it to their babies...

You can tie all the people up and some will still get loose.....

[andvoodoo2]

You are st.upid beyond belief.

I was an HIV counselor for 8 years. I've known women who were infected by their husbands. I told a teenage girl who had never had unprotected s.ex in her life (and only had had one teen boyfriend) that she was HIV positive. She had been ra.ped by a trusted family friend.

"Infected mothers stop getting pregnant.."? Do you realize most women don't know they're infected UNTIL they get pregnant?

Next time you have a thought, let it go. And, know this: Even id.iots like you can get infected, assuming anyone ever has s e x with you.

[ObjectiveRealist]

The poor paraphrasing suggest minimal scientific literacy on the part of the author, Maria Cheng.

[
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.
]

So, they did use data -- from South Africa and Malawi -- although two paragraphs above, it was stated that the study "is based on assumptions *rather* than data," the usage of "rather than" typically meaning "to the exclusion of." Computer modeling uses nothing *but* data and computations, carried out as rapidly as possible. It is the only ethical way of estimating efficacy of programs such as the ones proposed.

Of course the proposal has logistical obstacles, but that is an artifact of the same phenomena, poverty and political instability, which are primary contributors to AIDS epidemics. No evidence is cited that supports the vague assertions of methodological problems. This is very reminiscent of old reporting of "significant doubts among scientists" about anthropogenic global warming. Hogwash.

[melakfilms]

I've just concluded my own hypothetical model to be released next month. We could wipe out 95% of heart disease and death caused thereby (#1 Killer in U.S.) if all Americans simply changed their diets and began exercising.

Simple, right?

[ID-TenTango]

We're a bottom line nation and society and the bottom line is that HIV and cancer are entirely too profitable. I don't see pharmaceutical corporations giving up their bread and butter that easily.

As much as I would like to believe and hope otherwise, I don't realistically see it happening. I emphatically hope I'm dead wrong though.

[andvoodoo2]

Wise words, my friend.

[BlackYowe]

That is not going to happen. We still have babies around the word dying from simple Diarrhea when it could be prevented with great ease. Whooping cough and TB are back and we can't get people in third world countries to even use condoms.

[Number1]

So let me see. Even though in a quarter of a century, they failed to come up with a cure, failed to come up with a vaccine, and failed to explain how a simply nine or so gene retrovirus could do all the things it is supposed to do, they are SURE that if everyone was tested, they could eliminate HIV in 10 years.

Well how sure are they about the efficiency of their tests? These are the same tests that assured us that 30% of Ugandands, 25% of Swazis, etc. were 'HIV positive', which would result in massive reduction of populations in Africa. However, contrary to all predictions and sense, these country's populations are dramatically larger today than they have ever been, with some of the highest population growth in the world.

Shouldn't there be some kind of test for HIV scientists, so they actually pay for it when their predictions are shown to be absolute bunk?

And now they swear they will eliminate HIV, by testing everyone, and they KNOW this because of a hypothetical model?

[blooddoc]

It's not unusual for possibility and practicality to be found on different sides of a wide chasm. Ideas that look good on paper frequently meet serious obstacles in real life. Another example is sickle cell anemia, a hereditary disease that could be eliminated in a single generation if - and only if - the carriers of the gene did not reproduce. The medical literature is full of potentially eradicable diseases which will be with us for a long time because of culture, cost, or lack of political will.

[TheAlchemist]

In Africa where a single copy of the gene has some protective effect from malaria, it doesn't seem likely that carriers will refrain from reproducing.

[raker]

I've read lots of overheated stories over the last twenty-five years about how we're on the brink of eliminating HIV, but this one take the cake. So it seems, if we had drugs that eliminate HIV (we don't) AND if we could get them to everyone in the world, to be taken according to a punishing regimen for the rest of their lives, (not possible) THEN we'd all live to die of something else. And if I had a million dollars I'd be a millionaire.

[Infostream]

They're talking about using existing drugs, because even if they don't permanently cure the disease, while on them people with HIV are not infectious. So if everyone who is poz was on meds, there would be no new infection. It is wishful thinking that everyone would stay on meds until HIV disappeared for sure.

But in the gay community in the United States, as men have regressed back to completely irrational unsafe-sex practices, the only thing that has kept the infection rate from going through the roof is the high number of HIV positive guys on meds. Unfortunately the powers that be refuse to educate the public that you don't catch HIV from someone who is poz and on meds. HIV is being spread by poz guys who are not on meds, which is the 50% STILL untested, and also the many who know but don't disclose beause they fear rejection.

The only sane strategy is to have safe sex with EVERYBODY, but unfortunately the tend is toward the fantasy that if the guy you're with doesn't tell you he's positive (even though you never asked), then anything goes.

[raker]

People who have success on HIV drugs remain infectious, even when the virus is "undetectable." Even if every poz person were on protease inhibitors and they were effective, they'd remain infectious, maybe less so, but still infectious. But of course, the drugs don't work for everyone, even if they could get them and take them two or three or four times a day and change regimens as they become resistant to this drug or that.

It's bad enough here in the US where these myths about how to avoid HIV infection keep people at risk, but in developing countries there are taboos against even acknowledging HIV, where people may be banished for being poz, where poz men seek young virgins for sex because they believe they'll be cured by passing the virus from themselves to the partner. Access to drugs is just one of many obstacles to managing HIV.

People have unprotected sex, unafraid of HIV because they think AIDS is over, AIDS is a disease of old gay guys, that HIV meds have virtually cured AIDS. But even among people who do well on the drugs, life is hard. A disfiguring redistribution of body fat is fairly common, and even with a first rate health plan, the $10, $20, $30 drug co-pays can run into the the thousands out-of-pocket per year.

[TheAlchemist]

This proposal would be prohibitively expensive in the regions that need it most.

At present the HIV epidemic in the third world resembles the behavior of the epidemic in the developing world as it was 20 years ago.

HIV won't be eliminated until the last carrier has died without passing it on to anyone else.

[edweird]

Thanks for sharing your story Matrix BC. As a long term survivor, I am disgusted by the cost of my medical treatment. I take six anti-retroviral medications that total about $40,000, a year! My quality of life is good, and my viral load is undetectable, but I have been forced into poverty by this disease. Medicare Part D pays for my meds, and the taxpayers are getting screwed. If I take a job I will be forced into the "donut hole" of coverage, and will be forced to apply to the ADAP that you spoke of.
We have left this epidemic in the hands of the private sector and corporate greed! People cannot take these meds indefinitely, and they will eventually develop resistance. Best of luck to you and goodhealth.

[TheMatrixCBC]

The point of all of this is to say that, no matter from where the money comes, the pharmaceutical companies are fully aware that these drugs are vital to the continued good health of one portion of the population, and that they will have to cough up to the dough to receive them, regardless of whether it comes from insurance, the government, or someone's bank account.

In the past five years, NUMEROUS studies have been done that have proven effective in combating, halting the progress, or (most recently, and dubiously) halting the HIV virus...NONE of which have been conducted in the continental US (one from Brazil, another in Switzerland). None of these treatments have been approved by the FDA, mysteriously enough, and often times, the tests that determine whether or not a patient is a candidate go unapproved due to technicalities, like calling a series of tests a "medical device," in an effort to block its usage.

[cmoncrief]

I am a person living with HIV, and also a medical social worker who has specialized in helping people with HIV/AIDS for about 14 years. I am astounded at the cognitive dissonance these "researchers" present. They clearly are academics with no actual knowledge about the challenges of dealing with HIV.

Let me tell you something - in the real world of day to day human activities, the world where I live, this concept will never work. It is inherently impractical from a position of patient compliance, difficult for a government to implement, and extremely costly. As noted, this plan is theoretical, and as we all know, the intersection of theory and reality are often far removed from each other.

HIV is an incredible boon for drug manufacturers. Think of this: they have a population of people with a life threatening condition who have a take a combination of meds in order to stay alive. Then, side effects start due to the toxic effects of the HIV meds, such as high cholesterol, diabetes, and cardiac damage . Consequently, more meds need to combat those problems. And, the best part is yet ahead for the drug companies. As the virus mutates, newer, more effective drugs are needed! HIV is a the perfect goldmine for pharmaceutical companies because it is a never ending treadmill of treatment.

TheMatrixCBC, I would like to know more about the Brazil and Swiss studies. Could you please post additional info?

[TheMatrixCBC]

I'm not a conspiracy theorist, and I don't have any particular antipathy against the people who conducted this "study," but being someone who is currently being treated for HIV / AIDS, my own theory as to why we will not have a cure within a decade is far more nefarious.

I am on three prescription medications to treat HIV, the total cost of which (per month) would be in the ballpark of $1800. When I was first prescribed these medications and went to fill the prescription, my insurance refused to cover them, and I had to go apply for ADAP (AIDS Drug Assistance Program), a government-funded program that provides assistance for people who are unable to afford their medications. Based upon your yearly income (proof of which requires a tax return, two checks from your current employer, a form of photo identification, your Social Security card, two utility bills for proof of residency, an arm, a leg, and the skull of a virgin-birthed baby boy), a case worker assesses your needs (much like a student load, only you don't have to pay it back) and decides what percentage of the cost of your medications ADAP will cover. If you make below $30,000, ADAP tends to cover all the costs, which is a godsend, because if you're making that much, you're barely scraping by after rent or mortgage, utilities, insurance, car insurance, gas, food...you get the picture.