Since the first discovery of HIV (Human Immunodeficiency Virus) in 1983, we now have reached its 30th anniversary. The global report of HIV epidemics by Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that 35 million people worldwide were living with HIV at the end of 2012. There were 2.3 million new cases and 1.6 million deaths due to AIDS (Acquired Immunodeficiency Syndrome) (UNAIDS, 2013). Sub Saharan Africa bears 70% of the global prevalence burden while South and South East Asia hold another 10%. Currently, 10 million HIV infected people are on ART (Anti Retroviral Treatment) among 25 million of those who are eligible for it. In the new consolidated guidelines on the use of ART, World Health Organization (WHO) recommended that ART should be initiated in all adults who reach a threshold of 500 CD4 cells/mm3 (WHO, 2013).
After the last two decades of deliberate efforts in research to end HIV epidemic, several observational studies and statistical models have demonstrated that ART could reduce HIV transmission. The results of recent large clinical trials support this concept and additionally embrace the Treatment for Prevention or Treatment as Prevention (TasP) which is also known as Test and Treat strategy. Some countries are now considering this prevention approach as part of a combination prevention program. The aim is to reduce HIV transmission by expanding ART use in those with HIV through the suppression of viral load (Paquette et al., 2014).
Nevertheless, whether or not such approach is generalizable and sustainable at a large scale and in a developing country setting is still controversial and in need of further investigations. As a public health personnel as well as an observer, I would like to discuss this disputable hypothesis from the general point of view.
Discussion according to Literatures
With the improvement of ART since early 1990s, two disciplines emerged for reasoning the preventive benefits of ART. Clinical pharmacological studies indicated that HIV drugs penetrate the genital tract. Subsequent observational studies proposed ART might play a role in preventing sexual transmission of HIV by infected person (Cohen et al., 2012). To date, this potential of ART has been ascertained by many observational cohort, ecological, mathematical modeling, and meta-analytic studies (Forsyth and Valdiserri, 2012).
A community-based study of 15,127 persons in Uganda demonstrated that the heterosexual transmission of HIV is rare among persons with significantly low level of viral load (Quinn et al., 2000). This was supported by a number of observational studies with HIV discordant couples in Zambia, Spain, Thailand, and the USA (Smith et al., 2011). Consequently, a prospective cohort among African adults showed that ART initiation lead to 92% reduction in HIV transmission risk after 2 years of follow up (Donnell et al., 2010).
A strong population level association between expanded ART, decreased viral...