ViewpointThe case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic
Section snippets
HAART and HIV prevention
HIV causes AIDS.32 The transmission of HIV from infected to uninfected people through exposure to an infected person's bodily fluids (mainly semen, vaginal secretions, breast milk, and blood) is established.33, 34, 35 More recently, HAART has been shown to reduce HIV-1-RNA plasma concentrations predictably to undetectable concentrations in most treated patients.36 International guidelines have uniformly recognised that sustained complete suppression of HIV-1-RNA is needed to achieve a steady
Cost effectiveness of HAART revisited
Traditionally, HAART has been deemed to be cost effective on the basis of patient-centred outcomes;55 however, this fails to consider the effect of HAART on HIV transmission. Regional incidence to prevalence ratios can be used to estimate the number of new HIV infections that have failed to materialise in 2005 in any given region. For example, to raise the index in North America to the level seen in developing countries, where access to HAART is limited, would take nearly 100 000 additional HIV
A potential HAART-driven HIV-control strategy
The patient-centred approach to HIV management is based on the use of HAART to modify the natural history of the disease with the expectation that HIV infection will be transformed into a manageable chronic condition. This approach is supported by many clinical trials and population-based studies showing that health outcomes, such as death or progression to AIDS, can be delayed as long as individuals are highly adherent to therapy and start treatment with CD4-cell counts of greater than 200 per
Conclusions
The present approach to the management of HIV/AIDS is clearly not sustainable, and the status quo no longer acceptable if we hope to control the continued growth of the HIV global pandemic. A prevention-centred approach to the use of HAART, as discussed here, would be challenging and would need careful consideration of associated emerging ethical issues. However, expanded free access to HAART on a global scale provides a potential means to curb the growth of the HIV pandemic. As such, expansion
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Elimination of HIV transmission in Japanese MSM with combination interventions
2022, The Lancet Regional Health - Western PacificCitation Excerpt :In the early years of the pandemic, condom use was the only method to prevent HIV transmission. After effective antiretroviral therapy (ART) was found to prevent HIV transmission to sexual partners,3 treatment as prevention (TasP) and test-and-treat4 became major components of global HIV prevention strategies 3,5 and led to the Fast Track strategy of the Joint United Nations Programme on HIV/AIDS (UNAIDS) to end the AIDS pandemic by 2030,6 along with the associated 2025 targets7 for interventions required to achieve this goal. In Japan, there has been a concentrated HIV epidemic among men who have sex with men (MSM) and MSM are considered the key population.
Next generation economics of universal HIV treatment
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