Offline: Ending the AIDS epidemic

published on August 2, 2014 in The Lancet

There are some articles journal editors will wish they hadn't brought to public attention. But there will also be papers they are immensely grateful to have published. One such Lancet paper is Julio Montaner's truly landmark 2006 viewpoint entitled, rather modestly now looking back, “The case for expanding access to highly active antiretroviral therapy [HAART] to curb the growth of the HIV epidemic”. The paper began by charting, since its inception in 1996, the rise and impact of HAART. Montaner and his team went on to hypothesise that, “A prevention-centred approach would therefore argue that treating 100% of HIV-infected individuals at once could greatly reduce HIV transmission.” The idea of treatment as prevention (TasP) was born. The concept was quickly proven in 2011 with publication of the HPTN 052 trial, in which immediate treatment with ART reduced HIV transmission events by 96%. It's hard to recall what a struggle it was to get ART taken seriously. In 2003, Jim Kim, now President of the World Bank but then an adviser to the late Director-General of WHO, Lee Jong-wook, led an initiative called “3 by 5”. Many critics thought getting 3 million people living with HIV onto ART by 2005 a crazy idea. I remember one WHO adviser at the time asserting that an entire generation in Africa would have to be sacrificed because treatment was an impossible dream. True, the target wasn't met, but the goal galvanised the global community to be much more ambitious. How different the story is today. UNAIDS reported this month that 12·9 million people were receiving ART globally by the end of 2013. UNAIDS has now set new goals—90—90—90: by 2020, 90% of people living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will be taking ART, and 90% of those receiving ART will have viral suppression. UNAIDS reports that, “Modelling demonstrates that achieving these targets by 2020 will enable us to end the AIDS epidemic by 2030”. That is some promise. So what next?

Richard Horton
The Lancet
Read The Full Story

View the full article >>

Tags:

Julio Montaner

BC Centre for Excellence in HIV/AIDS

Search form

Offline: Ending the AIDS epidemic

Search form