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An end to the AIDS epidemic? Study provides
new reason for hope
BY ROSEMARY BLACK
DAILY NEWS STAFF WRITER
Wednesday, November 26th 2008, 4:04 PM
Sinai/Getty
A shelter in the Congo that cares for children with AIDS. A new study predicts that the disease could be
eradicated in 10 years with relentless treatment and testing.
What would it take to eradicate AIDS in the next 10 years?
With regular testing and treatment in countries with high infection rates, the virus could be
virtually eliminated in a decade, according to research published Tuesday in the medical journal The Lancet.
Based on a new mathematical model, the study was authored by Charlie Gilks, who is an AIDS treatment
expert at the World Health Organzation, and his colleagues. They used data from South Africa and Malawi,
countries with high infection rates.
In the model, people were voluntarily tested every year and immediately given drugs if they tested positive
for HIV, even if they were symptom-free.
Within 10 years, HIV infections dropped by 95 percent. The strategy would cut the estimated number of
AIDS deaths between 2008 and 2050 by about half, from 8.7 million to 3.9 million.
Local HIV experts feel that the research is intriguing but has some stumbling blocks.
One problem is that in order for the strategy to work, everyone diagnosed with HIV would immediately start
on medication, making them less likely to transmit the virus to someone else.
"But the drugs are associated with toxicity and other side effects, and once the person starts the drugs they
must keep taking them," says Dr. Antonio Urbina, medical director of HIV/AIDS Education and Training at St.
Vincent's Hospital. "If you start a person earlier and the drugs fail earlier, then that patient may have run out
of options."
Currently only 3 million people worldwide are on AIDS drugs, and nearly 7 million people are awaiting
treatment. It's estimated that some 3 million more people were infected last year.
Besides the fact that doctors don't know if it's safe to take AIDS drugs for decades, handing the drugs out to
everyone who tests positive could worsen drug resistance. And the steep costs for testing and the drugs are
also prohibitive. Experts feel the strategy's cost would peak at around $3.4 billion a year, although expenses
would drop after an initial investment.
The lifetime cost of treating someone with HIV ranges from $600,000 to $1.2 million, Urbina says. Some
97,000 New Yorkers are infected with HIV and of these, about 61,000 are living with AIDS. About 21 percent
of those with HIV are unaware of their status, Urbina says.
The new data is worth exploring further, says Dr. Donna Mildvan, chief of infectious diseases at Beth Israel
Medical Center and a professor of medicine at Albert Einstein College of Medicine.
"It may or may not work but it puts on the table some very intriguing possibilities that ought to be fully
explored," she says. "If you can control the virus with medications, then you can reduce transmission of the
virus from person to person. Of course, that depends on everyone taking their medicines religiously every
day, and that is millions of people."
Dr. Andrew Gotlin, HIV specialist at the Ryan Chelsea Clinton Community Health Center in Manhattan, says
the data has "some fundamental problems."
But, he adds, "If we could provide the testing on a larger basis to take away some of the stigma, this would
increase the number of patients who get tested, and we would find the patients who are positive and
hopefully find them appropriate care."
Adds Mildvan, "For every treated patient, that is one fewer patient who is going to perpetuate the epidemic."