B.C. AIDS researcher proposes method to 'extinguish' HIV epidemic

Expanding free access to drug therapies for everyone infected with HIV could eventually stop the spread of the virus, says a leading Vancouver AIDS researcher.

The hypothesis is based on mounting evidence that transmission of the virus drops significantly when people take anti-retroviral drugs, asthe amount of virus circulating in their blood goes down.

If viral loads drop to undetectable levels, it's as if HIV is quarantined and can no longer be transmitted to others.

Dr. Julio Montaner, director of the B.C. Centre for Excellence in HIV/AIDS, proposed the idea in a viewpoint article appearing in Saturday's special issueof medical journal The Lancetdevoted to AIDS research.

"This is a mathematical model, if you want to call it that way, that suggests that if we were to aggressively expand the anti-retroviral therapy use, we could see a very substantial decrease in transmissions," Montaner said.

"In fact, over a period of three to four decades, we could see an extinguishing of the HIV epidemic."

The model is theoretical, based on datafrom Taiwan showing new infections fell 53 per cent after free access to highly active anti-retroviral therapy or HAART was introduced.

Montaner cautioned the idea is a secondary preventive measure, not a licence for careless sexual behaviour.

Testing idea

The simple idea could be cost effective if it reduces the mounting incidence ofcases of HIV/AIDS worldwide, Montaner and his co-authors said.

The current approach is not sustainable given the growth of the HIV global pandemic in the face of prevention and treatment strategies that aren't completely effective and the lack of a preventive vaccine, they said.

"We have received a lot of encouraging support from our colleagues not only in North America, but in the rest of the world," said Montaner, who also chairs AIDS research at the University of British Columbia.

But the idea was dismissed by Dr. Philip Berger, a Toronto physician who has been working in Lesotho, an African nation where an estimated 23 per cent of adults are HIV positive.

People who are infected with HIV may not be willing to start taking antiretroviral drugs before treatment is needed, given its side effects, Berger said.

In sub-Saharan Africa where people are dying because of lack of treatment, the priority should be on meeting emergency needs now, he said.

Montaner now hopes to test the hypothesis with his own study in B.C.