Treatment prevention for AIDS?

When new evidence broke out that oral Retroviral drugs (ARVs) could prevent HIV prevention there was renewed hope for the drugs as the much sought after breakthrough for HIV prevention.

Full of optimism Joint United Nations Programme on HIV/AIDS (UNAIDS) executive director Michel Sidebe, described it as ‘’game changing’’ and AIDS activists said this might be the magic bullet that people had been waiting for.

According to the results of the HPTN 052 randomised study, earlier data confirmed that if the HIV positive partner in a discordant relationship  took ARVs , transmission to the HIV negative partner was ‘’virtually eliminated for at least more than two years.”

This was especially exciting for proponents of immediate treatment for anyone who tests HIV positive regardless of their CD4 count whether or not they were presenting with symptoms associated with the virus.

Italian scientist Paolo Marondela is supporting pilot schools in the east of Zambia which teach HIV prevention education from pre-grade so that children grow up learning about the dangers of AIDS and how to protect themselves and to stigmatize the disease.

He argues that early or immediate treatment for HIV positive people would reduce infection rates substantially in populations like Zambia where it is estimated that one in four people is infected with HIV.

A professor in urology and sexology based at the University of Pavia in Italy, Marondela said  if countries where the HIV prevalence was high decided to put all HIV positive people on treatment regardless of the CD4 count, AIDS would be ‘’stopped overnight’’.

Medical doctor Shawn Bwalya agrees adding that prevention is by far the cheaper alternative. ”You will have less people suffering from opportunistic infections or falling ill as a result of AIDS. At the end of the day, it would be cheaper to stave off illness with a pill that costs several dollars, than treatment which could run into hundreds.”

Bwalya says the arguments by critics that there would be drug resistance due to poor adherence for a variety of reasons, or due to long usage was not valid because if that were the case, antibiotics would not be a solution for diseases.

“Antibiotics are prescribed routinely for long periods of time, people adhere sometimes, other times not, sometimes they develop resistance and they need to change medication, but at the end of the day antibiotics are still in use, because at the end of the day, its medication, it helps the healing process……with regards ARVs the math is easy, spend a little now so that you save bigger later.”

There are divergent views in the AIDS movement.

On the face of it, the arguments make a lot of sense, AIDs activist Carol Nawina who runs an NGO helping HIV people co infected with tuberculosis. She says in an ideal world, everyone who tests positive should start ART, but the situation especially in Zambia is far from ideal.

Though Zambia has managed to put more than 400,000 of the about 500,000 people that need to go on ARVs on treatment, Nawina says there are problems with the roll out which need to be sorted before the net is cast wider to enrol more people.

“We are failing to provide continuous treatment for the ones that are already on ARVs, we have treatment failure because of lack of treatment literacy, we have stock outs and don’t have the necessary labs to makes sure that people are compatible with their drugs or have the right combinations- how can we deal with a larger population on treatment.”’

More importantly she says the treatment roll out is too donor dependent and she fears that once co operating partners exit, there will be a lot of people unable to continue treatment and the problem of drug resistance due to discontinuous will be far greater.

Peer educator and member of the International AIDS Society Samuel Kumar is more emphatic, he says putting HIV people on treatment regardless of their status would be ‘’catastrophic’’.

He says starting early treatment creates an opportunity for the virus to develop resistance; adherence for a seemingly asymptomatic person would be difficult meaning skipped doses and creating different strains of the virus as well as creating the need for second third and fourth line drugs.

“”ARVs are toxic “” Kumar says and should only be taken when needed and not prophylactically.

But Felix Mwanza who heads the TALC literacy campaign has a different argument; he thinks the results of the research will pressure government or policy makers into focusing on getting more people on treatment.

In countries like Zambia, which rely heavily on donor funding for their ARV roll out, knowing that the ‘’solution to high epidemic is treatment,” it might spur them to prioritise their national budgets for ART and the accompanying laboratory facilities.

“This might make governments think more strategically about how they can fund their roll outs and get to grips with the pandemic.”

– Zarina Geloo