Seek and treat to optimize HIV and AIDS prevention

published on November 26, 2012 in CMAJ

Since 1996, highly active antiretroviral therapy (HAART) has transformed HIV into a chronic, manageable condition. HAART fully suppresses HIV replication, driving the HIV load in plasma to undetectable levels. This allows for immune reconstitution, long-term remission and dramatic reductions in morbidity and death. Today, a 20-year-old who receives a diagnosis of HIV and treatment with HAART can expect to live until the age of 73 years.

In addition to beneiting individual patients, HAART has been shown to prevent vertical and parenteral transmission of HIV. More recently, a prospective randomized trial showed that use of HAART decreased HIV transmission among HIVserodiscordant couples by more than 95%. The populationlevel preventive impact of HAART has led the US government to announce a policy goal of “an AIDS-free generation.” HAART is widely available in Canada. However, we are not fully beneiting from it, because too many of those infected are diagnosed late, sometimes very late. The Public Health Agency of Canada estimates that at any one time at least a quarter of those infected are unaware of their infection, and more than 50% receive the diagnosis after immunodeiciency is established. Late diagnosis not only limits the effectiveness of HAART, it also promotes HIV transmission, because individuals who haven’t received a diagnosis are less likely to take appropriate precautions.

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Seek and treat to optimize HIV and AIDS prevention

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