The antiretroviral drugs that are used to treat HIV infected individuals may also help to stop the virus from spreading if given soon after being infected.
There are two known examples of antiretroviral treatment preventing the transmission of HIV. Healthcare workers who have accidents involving potentially HIV-infected bodily fluids are given an antiretroviral cocktail to prevent HIV infection within hours of the accident. HIV infected pregnant women given antiretroviral drugs decrease transmission of the virus to the unborn fetus by at least 98%. While it’s not possible to give these drugs in a matter of hours to every individual who is exposed to HIV, regularly testing and immediate treatment of those found to be HIV positive is one way to decrease transmission. This is the recommendation of Brian Williams, an epidemiologist at the South African Centre for Epidemiological Modeling and Analysis.
An unfortunate paradox has emerged due to the discovery of antiretroviral drugs. Although HIV is no longer the death sentence it used to be, those living with HIV are not necessarily changing their behaviors, i.e., safer sex and having fewer sexual partners. That means many people, about 33 million worldwide as of 2008, are living with HIV/AIDS and possibly engaging in high risk behaviors. Dr. Kenneth Mayer, a professor of medicine and community medicine at Brown University says that more people are being infected with HIV than dying due to the complications of HIV/AIDS.
When an HIV infected person is treated with antiretroviral drugs, the viral load drops by a factor of 10,000, decreasing his or her infectiousness by 25 fold. The viral load in the body is low when a person is initially infected, so decreasing it early on would significantly decrease the viral load and infectiousness.
This approach is not cheap. Williams and his colleagues recommend annual testing for everyone over the age of 15 and it is estimated that it would cost South Africa $3 to $4 billion a year. But the cost of hospitalizing individuals due to the opportunistic infections that those with HIV/AIDS are susceptible to and losing young people who would have contributed to society is much higher.
There are estimated to be 20 to 25% of HIV infected individuals in the United States that are not aware of their status. That means 1 in 4 to 1 in 5 Americans who are HIV positive do not know they are infected, and may be unknowingly infecting others.
Early treatment appears that it could an effective approach to decreasing the spread of HIV, but if people are not tested, this approach is useless. Part of HIV education should not only provide information on how HIV is spread and how to decrease the risk of infecting oneself and others, but also why getting tested is so important. This study is a very good one. This study may also be the catalyst for mandatory HIV testing, at least in South Africa. [CNN]
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