IDWeek: Much to do to “turn off the tap” of HIV transmission

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IDWEEKLOGOScience Speaks is live-blogging from IDWEEK 2013. Meeting in San Francisco from Oct. 2-6, with the theme “Advancing Science, Improving Care,” the conference features breaking scientific advances and approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases, including HIV and TB.

Although HIV transmission rates have declined over the past decade, “we still have much to do to turn off the tap,” said Dr. Connie Celum on Thursday at an IDWeek session on the latest advances in biomedical HIV prevention methods.

Celum outlined the latest innovations in HIV prevention that promise to make a sizeable dent in the HIV epidemic, including HIV treatment , medical male circumcision, and pre-exposure prophylaxis use.

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Dr. Connie Celum

While various prevention methods have contributed to a decline in transmission, the most effective prevention method, Celum said, has been the global scale up of antiretroviral therapy in the hardest hit places, thanks to programs like the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight HIV, TB, and Malaria. UNAIDS’ recent statistic of a 33 percent decline in HIV transmission globally since 2001 can be largely attributed to the scale up of antiretroviral therapy.

With the World Health Organization’s recent release of new guidelines, an additional 15 million people are eligible to receive treatment, Celum said, and emphasized that getting more people tested for HIV is a critical first step to further scaling up treatment.  As most people infected with HIV in Africa are unaware that they’re infected, scaling up HIV testing is crucial.

Quality of treatment delivery matters greatly, Celum said.  Not only is it important to get people on treatment, it’s also important to treat them properly, or else the prevention benefits of treatment won’t be realized.  She cited a Chinese treatment-as-prevention study that showed a mere 26 percent reduction in HIV transmission among serodiscordant couples – a dismal statistic compared to the 96 percent reduction in transmission thanks to treatment shown in the ground-breaking HPTN 052 study.  The small impact of the Chinese study may be associated with the poor quality of treatment delivery.

Celum emphasized the importance of implementing innovative testing methods as well as combination prevention methods, such as home-based testing and community-based and mobile testing.  Self-testing is also becoming increasingly popular, she said, with the OraSure home self-test – that was approved by the FDA last year – gaining  traction in Malawi where it’s seen over 99 percent accuracy and high acceptability.

Not only does getting people tested matter, but getting them to start treatment is also key, Celum said.  She explained that studies have shown substantial attrition between testing and antiretroviral therapy initiation in Africa.  Celum said new data has shown that willingness to start antiretroviral therapy is not universal, with many people perceiving treatment as being only for people who are on the brink of death.

Celum presented promising data on pre-exposure prophylaxis as well, citing studies that have shown that PrEP use does not increase risky sexual behavior among serodiscordant couples in Africa.

Celum  said that as each prevention method offers partial protection, combining prevention methods is the best way to move forward.  Those who are infected with HIV should receive prevention-of-mother-to-child-transmission services and family planning services, condoms and risk reduction counseling, co-infection prevention and treatment, and safe injection equipment and opiate replacement therapy.

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