Only a short time ago contracting HIV was a death sentence. So it’s a minor miracle that a study in this week’s Lancet can report that HIV-infected patients are living 13 years longer now than they were in 1996* (paper, news coverage).
“These advances have transformed HIV from being a fatal disease, which was the reality for patients before the advent of combination treatment, into a long-term chronic condition,” says study author Jonathan Sterne of the University of Bristol (press release).
Now for the bad news. First up these results are in high-income countries, and no-one should need reminding about the dreadful situation in parts of Africa and elsewhere in the developing world. And another paper in the Lancet this week is warning that recent HIV advice from the Swiss government could put a serious dent in efforts to stop the spread of the virus.
The Swiss Federal Commission for HIV/AIDS has suggested people who are HIV-positive but are being successfully treated** with antiretrovirals are sexually non-infectious. Authors of a paper in the Lancet modelled what would happen if people took this advice, and claim that it would correspond to “an increase in incidence of four times compared with incidence under current rates of condom use”.
“The Swiss statement was not sensible at the public health level,” says David Wilson, a researcher at the University of New South Wales (New Scientist). “The logical consequence would be that people would stop using condoms – our study shows that that would increase the risk of HIV transmission substantially, especially among men who have sex with men.”
Over 10 years 215 new HIV cases would be created by female-to-male transmission in a population of 10,000 heterosexual relationships with HIV-positive female and HIV-negative partner. There would be 425 for male-to-female transmissions in a 10,000 population and 3524 for male-to-male transmission.
“If the claim of non-infectiousness in effectively treated patients was widely accepted, and condom use subsequently declined, then there is the potential for substantial increases in HIV incidence,” write Wilson and colleagues.
Jonathan Anderson, president of the Australasian Society for HIV Medicine, says, “Antiretrovirals can complement consistent condom use but replacing condom use with medications may end in disaster.” (Reuters.)
More
Lancet study blasts Swiss stance on HIV protection – AFP
Australasian Statement on HIV Antiretroviral Therapy and Infectiousness
*technically life expectancy went up by 13 years between the period 1996-99 and 2003-05.
**defined as undetectable levels of plasma HIV RNA
Image: AIDS virus (HIV). computer model produced by Richard Feldmann / NIH