ID Week: Treatment is Essential to Bending the Curve of the Epidemic but Challenges Remain

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SAN DIEGO, CA — Dr. Wafaa El Sadr of Columbia University offered an ID Week presentation Thursday about the impact of treatment on the global epidemic and the new promise of changing the trajectory of the epidemic by scaling up treatment both to save lives and reduce HIV incidence.  She reminded her audience that treatment has already had a major impact.  There have been dramatic reductions in all-cause mortality in PEPFAR-supported countries and a 25 percent reduction in HIV incidence in many countries in sub-Saharan Africa.  Treatment scale-up has also delivered dramatic increases in productivity in countries where antiretroviral therapy has been made accessible to workers

Nevertheless, 2.5 million people continue to be infected with HIV every year.  There are 7,000 new infections every day and 1,000 of those infections are in children.  HPTN 052 has demonstrated that we may in fact be able to treat our way out of the epidemic, but we must figure out how?

El-Sadr outlined some of the major challenges:

  • Many individuals remain unaware of their status
  • Late diagnosis of HIV infection is common in both developing and developed work settings
  • There are frequent failures in linking positives to care
  • Late initiation of HIV treatment is common
  • There are huge challenges in ensuring that patients achieve and maintain viral suppression

El-Sadr argued that integrated strategies must be part of an effective response, including biomedical, behavioral and structural interventions.  Ongoing studies will inform how to implement and scale up such interventions and determine the risks and benefits of early ART.  She highlighted the three major combination prevention trials funded by PEPFAR and now beginning to enroll in Africa, as well as the START study which is looking at the risk/benefit to the individual of immediate ART. In addition, El-Sadr emphasized the need to pay attention and tailor effective responses to key populations, notably men who have sex with men, commercial sex workers, and injection drug users and argued that their engagement in prevention and care is vital to realize our goal of ending the pandemic.

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