On World AIDS Day, the Evidence for Prevention With Anti-Retroviral Therapy Is Powerful

published on December 1, 2015 by Anthony S. Fauci, MD, in AJMC

Thirty years ago, fear of AIDS was at its height. The year 1985 brought the first commercial blood test to detect HIV, the military began testing recruits for the virus, and the first international AIDS conference convened in Atlanta. The actor Rock Hudson shocked the world when he announced he had the disease and died shortly later.

A young Indiana boy named Ryan White, who had contracted AIDS from contaminated blood products, forever changed the discussion after he was denied admission to his middle school. Instead of staying quiet, White and his mother went public to highlight AIDS stigma and the need for more research.

It would take another 11 years—and another 254,860 deaths in the United States alone—before the first anti-retroviral therapy (ART), fueled by a powerful protease inhibitor, would slow the tidal wave. In the first year after approval of ART, the number of known deaths from AIDS in the United States was cut in half, from 34,947 to 17,403.

When ART arrived, the idea that it might someday be used to end the pandemic was unthinkable, but that is the concept behind World AIDS Day 2015: Getting to Zero, End AIDS by 2030. It’s also the message from the nation’s longtime warrior against AIDS, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, who writes today in the New England Journal of Medicine with Hilary D. Marston, MD, MPH, the agency’s policy advisor for global health.

In “Ending the HIV-AIDS Pandemic—Follow the Science,” Fauci and Marston make the case that there is sufficient evidence to support widespread use of ART for prevention of AIDS, not just treatment. They review results from 3 key trials, which have taken place from 2006 through 2015, that answered 3 distinct questions:

(1) Do the long-term benefits of ART outweigh the risks, particularly on the cardiovascular system?
(2) Can suppression of the virus prevent it from being transmitted to others, especially an intimate partner?
(3) How early should we treat patients?

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On World AIDS Day, the Evidence for Prevention With Anti-Retroviral Therapy Is Powerful

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