Last week, I was fortunate to hear a talk at the Population Council given by the inspiring Dr. Wafaa El-Sadr. Dr. El-Sadr is the founder of International Center for AIDS Care and Treatment Programs (ICAP) at the Columbia University Mailman School of Public Health and an expert on global HIV prevention and treatment.
She touched on many aspects of HIV infection, giving both a global and historical perspective that should inform our thinking as we approach the future. One point that she made was an idea that I had not heard before, and struck me largely both for its simplicity and its innovation.
The idea is that HIV treatment is HIV prevention.
And, that is a novel way to think about HIV at a time when creative ways of thinking are what we need. We have been waiting for an HIV vaccine for over thirty years and, although hopes are high that one will exist one day, we have to proceed with the tools that are in our arsenal at the moment.
The idea of treatment as prevention (TasP) came about, in large part, after a seminal study was published in the New England Journal of Medicine entitled “Prevention of HIV-1 Infection with Early Antiretroviral Therapy.” This study looked at 1763 couples in which one person was HIV+ and the other HIV-, and saw a drastic reduction in the amount of HIV transmissions in the couples where early initiation of ART was started (96%,) when compared with delayed therapy.