Predictions of The Demise of AIDS

Jim Burroway

November 26th, 2008

Don’t get your hopes up, but the Associated Press is reporting on a study published online Tuesday in the respected journal The Lancet, which, using complex mathematical models, predicts that HIV could theoretically disappear within a decade if everyone living in countries with high infection rates are regularly tested and treated.

Caution is always wise when reading about research like this. Mathematical models on HIV/AIDS regularly come and go. I’m not aware of very many which have proven to be accurate as a predictive tool, and I doubt this one will be either since it’s is loaded with assumptions which simply aren’t realistic. I don’t have the full-text article, but the short abstract alone doesn’t give much reason for optimism.

The predictive model was based on data from South Africa and Malawi using a number of assumptions. The model assumed that people would be voluntarily tested each year and immediately given drugs if they tested positive for HIV, regardless of whether they were sick. That last assumption alone is problematic. Even if drugs were available for everyone, having them take it even when their HIV infection hasn’t progressed to AIDS is fraught with controversy. AIDS medication has several serious side-effects, and the long-term effect of taking these powerful drugs is unknown. The longest that most of these drugs have been available is only about ten years.

The model also assumes that all HIV transmission in South Africa is heterosexual. While HIV is predominantly transmitted heterosexually in South Africa, this assumption  does represent a strange gap in the model.

Another concern not mentioned in the abstract is the assumptions they used concerning the transmissibility of HIV in people who are infected but are on Highly Active Anti-Retroviral Therapy (HAART). We do know that HAART can drive viral loads to undetectable levels in most cases, and thus reduce the risk of transmitting the virus onto others. But that risk of transmission is not zero, and besides that, viral loads can fluctuate — for example, when the patient has a cold or flu.

But if all the model’s assumptions did hold true, this model suggests that HIV could be theoretically eliminated in a decade. The cost test and treat everyone as the study suggests would be staggering, but no more staggering than the way we are doing things now:

“We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US$1-7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease.

I doubt that we will see the demise of AIDS within ten years, but its incidence could be significantly reduced. This model clearly demonstrates the benefits  of universal testing and treatment to society overall, not just to those who are infected today. Sticking with current policies all but guarantees the continued growth of the pandemic worldwide.

Ephilei

November 26th, 2008

See as the Third World still struggles with far simpler diseases that do have cures, AIDS won’t go away on the global scale. AIDS won’t go away until poverty goes away.

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