Identification and Treatment of People with HIV and Injection Drug Use will Help Reduce Transmission of HIV

One approach to reducing the transmission of HIV infection is a “test and treat” strategy: regular testing of individuals at risk for HIV and initiation of treatment among those who test positive. Researchers used data from a cohort of people with injection drug use in Amsterdam to model the effect of initiating combined antiretroviral treatment (cART) at different stages among those with HIV.

• Initiating cART at low CD4 counts (<350 cells/mm3) did not reduce transmission because the reduced infectiousness was largely offset by the lengthening of infectious lifetime.
• A test and treat strategy would reduce about half of new infections over a 30-year time period.
• HIV infection could eventually be eliminated in the population if individuals began cART on average 1.6 months after becoming infected. This would require testing at least every 3.2 months.

Comments:

This study demonstrates how identifying and treating individuals newly infected with HIV can have a significant impact on transmission. However, this requires frequently testing at-risk individuals and having them initiate and adhere to lifelong treatment during an asymptomatic phase of the disease. The results of this study underscore the vital importance of reaching out to and engaging at-risk populations.

Darius A. Rastegar, MD

Reference:

de Vos AS, Prins M, Coutinho RA, et al. Treatment as prevention among injection drug users; extrapolating from the Amsterdam cohort study. AIDS. 2014;28(6):911–918.