Can it be?

There was much to talk about within the HIV/AIDS research, advocacy and policy community last week. UNAIDS released a report stating reduction in new HIV infections worldwide, 20% less in 2009 compared to the 1990s.  (to download a copy of the report, visit http://www.who.int/hiv/pub/global_report2010/en/index.html).

More access to antiretroviral medications is partly due to the success of HIV/AIDS reduction in the last few years. Millions more are on treatment due to the joint effort of public and private sectors in fighting the spread of HIV/AIDS. Prevention programs are proving successful in altering behavior among young people as well. These improvements are noteworthy and give us hope for the future.

Yet, we must remain cautious. The report also noted that while some countries showed great improvements in HIV/AIDS prevention and treatment, others have faired far worse. Regions that have never before have had to deal with high incidence rates are now facing a new struggle. Countries in Eastern Europe and Central Asia, for example, experienced a 25% increase in HIV incidence, mostly due to heroin-injectors.

In light of difficult economic times worldwide, the question becomes whether those vested in global health will continue to provide funding to target these new struggles. Cost-benefit analysis will become ever more important.

I said there was much to talk about within the HIV/AIDS community. Well, it just so happened that  the New England Journal of Medicine released a hopeful report last week showing the effectiveness of Truvada, a combination of antiretroviral medications, in preventing new HIV infections. The success rate was astounding, those who took the pill faithfully showed 90% effectiveness in preventing infection. Advocates and experts welcomed the results of this study, and I also find myself pondering how this pill could change the global HIV/AIDS outlook.

Prevention through the use of one pill sounds like a good deal. To provide the pill to vulnerable populations would not only reduce the number of people living with AIDS but also reduce costs related to treatment of HIV/AIDS. The question that remains is again related to cost: who will pay for the pill? It goes without mention that an additional cost of this pill are the new programs and training needed to distribute it. I ask, can we save the world with one pill?

Many more studies will have to be conducted to fully evaluate the effectiveness of Truvada. Researchers would do well to study the behavioral effects of the pill: will people on the pill become less careful in their daily activities, thereby decreasing the effectiveness of the pill? It will take years to study the full effects of Truvada and until we can make a sound claim for the global health community to fund the use and distribution of this medication. But for now, we can hold to hope.

What do you think? Should the pill be used now worldwide?

For a summary of the studies on Truvada, visit: http://www.nytimes.com/2010/11/24/health/research/24aids.html?_r=1&ref=health

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