Could general screening for HIV be the best way to save poor countries?

[30 July 2009 - 11h26]

Much discussed during the 5th International AIDS Society Conference in Cape Town, South Africa, the implementation of “preventive” antiretroviral treatment following very extensive population screening would be “without doubt the best weapon in reducing transmission”. This is the opinion championed by Professor Pierre-Marie Girard (of the Infectious and Tropical Diseases Unit at the Saint-Antoine University Hospital in Paris, France), an acknowledged specialist in the epidemiological and clinical situation in sub-Saharan Africa. “If you have a million HIV positive individuals and you put them under treatment, you will reduce virus transmission drastically, he explained.

As we know, the disappointments registered in vaccine research and in other means of medical prevention explain this general interest in preventive tritherapies.

Some, however, are questioning whether this can be a realistic solution for the countries of the South, where only 35% of those infected and needing treatment have access to antiretrovirals.

Screening to treat

It is, however, an option that is gaining ground. It would mean far wider screening for infection, followed by treatment of those who test positive for HIV. The objection that those concerned do not observe treatment is no longer an issue. For two years now it has been shown that Africans are very good at observing treatment. Furthermore, “today, tritherapies make it possible to achieve an 85% success rate, in Africa and elsewhere. We have shown that this is an approach that can work and that it produces results that are identical or even better than those in the countries of the North”, points out Jean-François Delfraissy, director of the ANRS (the French National Agency for AIDS research).

Can this technically realistic policy in fact be realised? Can the necessary resources be found? The mathematical models developed by the ANRS appear to show the validity of this reasoning. “There is certainly a great deal of investment needed at the start, admits Pierre-Marie Girard. But by the end of 2030-2035, the reduction in transmission will be such that the operation will be financially efficient.

But the politicians remain to be convinced. Maybe we will get a response in about 2 years time. Professor Jean-François Delfraissy tells us in fact that teams at the ANRS are preparing “a feasibility trial, maybe in partnership with the American National Institute of Health and the WHO. This could take place in the north of South Africa and will, researchers hope, establish whether the possible can become probable if the financial resources are available. That’s a lot of ‘maybes’, but nevertheless remains a genuine hope.

Source : from our special correspondents at the 5th IAS Conference, Cape Town, 19-22 July 2009; interview with Pierre-Marie Girard, 20 July 2009; interview with Jean-François Delfraissy, 20 July 2009

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