The coronavirus disease 2019 (COVID-19) pandemic has produced the fear and disorder inevitably provoked by emerging pathogens. As such, it should also inspire consideration of our experience with HIV over the past 40 years. As with HIV, the road to reducing infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19), and attendant morbidity and mortality, requires medical and nonmedical strategies. The most important lesson learned from tackling HIV is to use a combination of prevention strategies.
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Historically, antiviral therapies that reduce the severity of infection have preceded the development of biomedical approaches to prevent onward transmission (although interruption of viral replication also offers a prevention benefit). The first HIV treatment, azidothymidine (AZT), extended life by up to 18 months, providing hope that HIV infection could be transformed from a death sentence to a treatable disease. Reduced risk of mother-to-child transmission by AZT was the first biomedical prevention against HIV transmission. This success was the precursor to “pre-exposure prophylaxis.” AZT also launched research focused on “treatment as prevention” where antiviral agents reduce the HIV viral load to a point where infected people no longer transmit. This approach, which uses combinations of powerful antiretroviral agents, is now the mainstay of HIV prevention worldwide.
For SARS-CoV-2, we have leapt into a cacophony of clinical trials of drug candidates with differing degrees of plausibility. Preliminary results from a large randomized controlled trial show that the antiviral drug remdesivir substantially reduced the duration of hospitalization for COVID-19. To date, COVID-19 testing results have been used primarily for patient isolation, contact tracing, and quarantine. But effective therapies will lend great urgency for the universal availability of rapid and reliable testing for SARS-CoV-2 infection, so that treatment can be provided when indicated.