the increased prevalence in men in Australia who have sex with men raises questions about treatment as prevention.
special section on HIV
Only 1253 people were diagnosed with HIV in Australia in 2012, shows nearly 3 decades of prevention efforts aggressive. But there is a troubling development Guard: The number of new diagnoses has jumped 10% over the previous year, and cases have steadily increased since 1999. And 70% of new infections among men who have sex with men (MSM)
[Every country in the world has struggled to slow the spread among MSM. But the growing problem in Australia has highlighted the limits of one of the most promising new prevention tools. A 2011 historic study showed that if infected people took their faithfully (ARVs) for antiretroviral drugs and had viral levels undetectable on standard tests, the risk of transmission through heterosexual sex has been almost eliminated, down 96% ( Science , 23 December 2011, p. 1628). Hopes rose that the addition of treatment as prevention to the arsenal of proven interventions could bring AIDS epidemics in the communities stopped.
Australia has universal health care and access to ARVs last, and most people who learn they are infected quickly begin treatment. In a study published in the July 2012 issue PLOS Medicine , epidemiologist David Wilson of the Kirby Institute for Infection and Immunity in society in Sydney noted that up to 75% of MSM in Australia said get tested HIV each year, and 70% of those infected received ARVs. In 0% of people, viral levels have been completely removed. But this did not prevent the increase in new cases among MSM. "Why is there a disconnect with" test and treat? "Ask David Cooper, who heads the Kirby Institute.
One possible answer is that treatment as prevention does not work just as well with MSM. Anal intercourse has a probability 18 times higher HIV transmission than vaginal intercourse, according to a study in 2010. MSM also tend to have more partners, which increases the chance that the virus spreads.
Wilson, a mathematical modeler and Chief Kirby monitoring division, also notes that more treatment means more people with HIV survive that can potentially spread infection, as some undoubtedly remain infectious. treated people can also indulge in behaviors more risk that, in a sense of the people, overwhelming benefits of drugs. and the virus is often transmitted by recently infected people who have yet to develop enough high levels of antibodies to detect on standard tests.
MSM-targeted Fear Direct Less More shows
IMAGE :. Australian AIDS FEDERATION OF ORGANIZATIONS / The NATIONAL ASSOCIATION OF PEOPLE LIVING WITH HIV / AIDS
Clearly, if every infected person has taken ARVs every day and had undetectable viral levels, the transmission would likely fall in MSM communities. But this is unrealistic. So Wilson and his team published an online modeling exercise on February 7 in Sexual Health who explored what it would take to lower HIV infection rates in the MSM population of Australia . The researchers studied the impact of early detection of infection and early treatment. But the factor that stands out the most was the treatment effect on the transmission.
If ARVs indeed lower the risk of transmission among MSM 96% -as much as it does for heterosexual and treat 0% of people would reduce new infections by 55% in 5 years. On the other hand, if ARVs are a simple protection of 26% among MSM, the same scenario would avoid a meager 9% of infections. "The jury is still out regarding the amount of treatment reduces infectiousness with male-male sex," says Wilson.
Even if it works as well for MSM, which Kirby Institute is studying, the country needs to increase significantly the number of people on ARVs and it is notoriously difficult to improve success.
0 Komentar