Strategic use of antiretrovirals means bringing treatment and prevention together

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Margaret Chan, Director General of the World Health Organization (WHO)  kicked off this Sunday  session by noting that advances in our knowledge mean:  “finally we have the upper hand and are in a position to outsmart HIV.”  But she also added that the challenges didn’t end with unlocking the biological mysteries of the virus, but have included the ongoing battle against stigma and discrimination and against policies that perpetuate HIV.  She lauded the contributions of the activists who “protested against stigma and discrimination, and against high drug prices and other access barriers.  She called the scientific proof that antiretroviral therapy (ART) not only saves lives but prevents new infections as “the most transformative evidence in recent years.”

“Could we be saving more lives and preventing even more infections by starting treatment even earlier? “, asked Chan, while noting that “ART also protects against TB, reducing risks by over 65 percent.”

When is the optimal time to start treatment? How high would coverage have to be at the community level to reduce incidence? Chan identified these as vital questions. More than 50 studies are underway to answer those and other questions.  She also acknowledged that “evidence and experience teach us that targeting those at high risk.”

She called the times ahead in the fight against the AIDS pandemic “exciting and promising” while assuring her audience that “we shall continue to look for new mechanisms to bring in new resources.”

A second WHO speaker, Anthony Harries spoke in his role as the chair of the WHO Strategic and Technical Advisory Committee on HIV about the WHO “perspective for future guidelines”.   The bottom line on the guideline issue is that the WHO will release “consolidated guidelines” on HIV next July that will be updated every 2 years. These guidelines will address the continuum of care for all ages and for all populations.  They will feature expanded operational and programmatic guidance in addition to their clinical focus and based on modeling and cost-effectiveness research.

 

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