The Scientific Advisory Board (SAB) of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program met in September to discuss the results of the HIV Prevention Trials Network (HPTN) 052 trial, which found that individuals with HIV infection who were given immediate antiretroviral therapy (ART) were 96 percent less likely to transmit the virus to their uninfected sexual partners than those whose treatment was delayed. Utilizing this exciting new evidence, along with existing science, the 052 subcommittee made a list of six recommendations to U.S. Global AIDS Ambassador Eric Goosby and the Office of the Global AIDS Coordinator that the full board approved, with the first four listed in order of priority as defined by the SAB:
- Accelerate the support of the scale-up of ART to all HIV-infected individuals with CD4+ cell count <350 cells/mm3, irrespective of World Health Organization (WHO) disease stage for treatment and prevention (Goal: 90 percent coverage)
- Offer ART to all patients with HIV-related tuberculosis (TB), irrespective of CD4+ cell count and integrated during TB treatment
- Endorse WHO guidelines for prevention of mother-to-child transmission (PMTCT) in pregnant and breastfeeding women with a CD4+ cell count >350 cells/mm3, with a preference for Option B (ART throughout pregnancy and breastfeeding) where locally appropriate
- Support the use of ART in specific populations with CD4+ cell counts >350 cells/mm3 in order to prevent transmission to others based on the results of HPTN 052. The benefit of this intervention has been demonstrated for heterosexual discordant couples. Careful evaluations, including assessment of benefit/risk/impact/feasibility and modeling exercises are urgently needed to identify populations that should be prioritized for this intervention, given local conditions
- Intensify efforts to establish effective programs for engaging key affected populations in HIV prevention, care, and treatment programs. Particular efforts should be undertaken to ensure key affected populations eligible for treatment receive ART in an enabling environment that supports their human rights
- Seek and secure sufficient resources to implement the recommendations, given the scientific basis for, and potential impact of, their implementation
The 34-page report (PDF) expands upon each of these recommendations, explaining in detail the full scientific rationale, health impact, resource implications, implications for PEPFAR, gaps in knowledge, and an examination of implementation issues that cross-cut many of the recommendations. An important “key consideration” in the recommendations, “Implementation will need to be adapted for the local epidemiologic context and conditions on the ground… These recommendations should, of course, only be considered if they are aligned with national guidelines and based on their relative impact in a given epidemiologic context,” according to the document.
In related news, the President’s Advisory Council on HIV/AIDS (PACHA) posted its 2011 World AIDS Day statement (PDF) to the PACHA website, in which it urges the Obama administration make a bold announcement about the important scientific advances and the potential they bring toward achieving zero new infections, zero-AIDS-related deaths, and zero discrimination. Included in the statement is a specific ask that AIDS treatment provided through the PEPFAR program be scaled up to cover six million people by 2013.