The Science and Practice of HIV Prevention. 2/8/10
Prevention as a strategy to defeat HIV.
2 August 2010
Prevention as a strategy to defeat HIV. The virus that causes AIDS. Two types of HIV are currently known: HIV-1 and HIV-2. Worldwide, the predominant virus is HIV-1. Both types of the virus may be transmitted by sexual contact, through blood, and from mother to child (either before or during birth, or through breast feeding), and they appear to cause clinically indistinguishable AIDS. However, HIV-2 is less easily transmitted, and the period between initial infection and illness is longer in the case of HIV-2. While some individuals experience mild HIV-related disease soon after initial infection, nearly all then remain well for years. As the virus gradually damages their immune system, they begin to develop opportunistic infections of increasing severity, including diarrhoea, fever, tuberculosis, pneumonia, lymphoma and Kaposi's sarcoma. HIV finally came of age at the International Acquired immunodeficiency syndrome. The late stage of infection caused by the Human Immunodeficiency Virus (HIV). HIV steadily weakens the body's defence (immune) system until it can no longer fight off life-threatening illnesses. These include infections such as pneumonia and certain cancers. AIDS Conference in Vienna last week.
The call for “an all-out, unprecedented effort towards HIV prevention” was made by Peter Piot and colleagues in The Lancet two years ago. At the beginning of the Vienna meeting, Julio Montaner's study of highly active antiretroviral treatment on HIV transmission in British Columbia, Canada, further showed that treatment and prevention are indivisible. As HIV intervention strategies, they are intimately connected.
To an overflowing conference hall and a standing ovation rarely seen at even this remarkably diverse meeting, Quarraisha Abdool Karim presented the main results of CAPRISA 004. This proof-of-concept study tested an antiretroviral microbicide (containing tenofovir) against placebo.
The 39 per cent reduction in HIV incidence was dramatic evidence that a microbicide can work. Although this was only a single study, the number of endpoint events was small, and the confidence intervals wide, this report is a turning point in HIV prevention science.
Perhaps less of a turning point—although we hope we are proven wrong—is a new UNAIDS High Level Commission on HIV Prevention. Launched in Vienna and co-chaired by Nobel laureates Francoise Barré-Sinoussi and Desmond Tutu, the Commission aims to lead “a global advocacy campaign between now and 2011 to build broad support for effective HIV prevention programmes”. There are reasons to be sceptical.
The Commission is replete with ex-political leaders with diminishing political power and influence—from Chile, France, and Botswana. There are celebrities—Magic Johnson—and private-sector leaders too. All busy people whose time commitment to the commission one might reasonably question.
There are commissioners one can have confidence in—Vuyiseka Bubula (General Secretary of the Treatment Action Campaign in South Africa), Irene Khan (a human rights expert), Peter Piot, and Mechai Viravaidya (Mr Condom, from Thailand).
The scientific advisory panel is chaired by the writer and journalist Laurie Garrett. What the products and certain condition, capability, or numerical measure which, when recorded, collected, and analysed, makes complex concepts more readily measurable and allows managers and evaluators to compare actual programme results with expected results.">indicators of success for the commission will be remain unclear.
What AIDS. The late stage of infection caused by the Human Immunodeficiency Virus (HIV). HIV steadily weakens the body's defence (immune) system until it can no longer fight off life-threatening illnesses. These include infections such as pneumonia and certain cancers.">AIDS 2010 seems to have shown is that the science of HIV prevention is now beginning to yield major successes. Whether the AIDS. The late stage of infection caused by the Human Immunodeficiency Virus (HIV). HIV steadily weakens the body's defence (immune) system until it can no longer fight off life-threatening illnesses. These include infections such as pneumonia and certain cancers.">AIDS community has the right strategies to translate those successes into policies remains to be seen.