Test, Treat & Go?

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The following post is by Andrea Weddle, Executive Director of the HIV Medicine Association, reporting from the International AIDS Conference in Vienna.

Danish researcher Susan Cowan coined the “Test, Treat & Go” phrase after presenting data suggesting that the prevention benefit of HIV treatment accounts for a lower HIV transmission rate in Denmark. The presentation part of an oral abstract session held Monday morning at the 2010 International AIDS Conference highlighted the unique factors in Denmark that make it a suitable environment for evaluating the prevention benefits of a “Test and Treat” or ”Test, Link and Care” strategy.

Denmark’s national health system offers free HIV testing and free access to antiretroviral (ARV) treatment for everyone with HIV with a standard for treatment initiation of CD4>350. The Danish epidemic is concentrated in MSM, of whom 77% report being tested for HIV disease, and 80% of known gay men with HIV on HIV treatment. Of those on treatment, 86% have an immeasurable viral load. With both the number of gay men living with HIV disease increasing thanks to universal access to treatment and the reported rates of risky sexual behaviors increasing – an increase in incidence rates would be expected.  Despite the change in these variables – annual incidence in the country has remained steady at 200 to 250 cases per year.

Cowan and her colleagues hypothesize that the decrease in the ongoing HIV transmission rate is explained by the prevention benefit of ARV treatment. As she suggested, their research adds to a growing body of evidence in support of including treatment in the “prevention armamentarium.” At a minimum, Cowan said “the data supports putting relative sexual transmission risk of HIV disease into perspective for individuals with HIV disease depending on their treatment status.”

Some attendees were critical of the explanation, with one countering the hypothesis by suggesting that an aging gay male population with fewer sexual partners could explain the decreased rate. Another attendee suggested a better name for a prevention-as-treatment strategy would be “Test, Treat and Counsel.”  In any case, the results offer more promise for the prevention benefits of treatment.

The abstract is available online (PDF), and is titled MOAC0103 – New paradigm for positive Prevention “Test and Treat” – testing for and treating HIV has lowered transmission rate in Denmark in spite of increased unsafe sex among MSM.

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