Providing HIV Treatment To Those Who Are Known To Be Infected Is Not Enough To Prevent Its Spread Among People Who Inject Drugs

People who inject drugs (PWID) are at risk for HIV infection and for transmitting the virus to others. One strategy for reducing transmission is to identify individuals who are HIV-infected and provide antiretroviral treatment (ART) to them (i.e., “test and treat”). Other strategies include preventive interventions (e.g., syringe exchange, reducing risky behaviors, and opioid agonist treatment). Researchers used data from Russia and Ukraine to model the spread of HIV among PWID and the effects of various interventions.

• Without any treatment or prevention, the HIV prevalence among PWID was predicted to reach 86% over 20 years. Providing ART to 50% of those infected on average 4 years after infection would only decrease this to 83%. Adding treatment for 25% of recently-infected individuals would provide a modest further reduction to 73%.
• The most effective strategy was scaling up preventive interventions and treating at least 25% of recently-infected PWID; this would lead to an estimated prevalence of 2% after 20 years.

Comments: This study shows how, in the absence of preventive efforts, HIV can spread in vulnerable populations and suggests that simply treating individuals with HIV infection will have little effect on the spread of the virus among PWID. The most effective strategy is a combination of primary prevention along with identification and treatment of recently infected individuals. However, social stigmatization of PWID presents a significant barrier.

Darius A. Rastegar, MD

Reference: Vasylyeva TI, Friedman SR, Lourenco J, et al. Reducing HIV infection in people who inject drugs is impossible without targeting recently-infected subjects. AIDS. 2016;30:2885–2890.