Opinion and Recommendations Regarding the Potential for Treatment as an Innovative Tool for Fighting the HIV Epidemic, Counseil National du Sida (2009)

This briefing paper from the Conseil National du Sida in France argues that the use of antiretroviral treatments, which have been shown to reduce the risk of HIV transmission by suppressing the viral load, may be a powerful prevention mechanism that should be further explored. While the paper concludes that treatment does not reduce the risk of transmission to zero, it maintains that the reduced rate of transmission that comes about from the consistent use of antiretrovirals (ARV) may help decrease new transmissions. (It is important for readers to keep in mind that the connection between use of antiretroviral therapy and reduced HIV transmission was first demonstrated in 1994, when NIH's "076" study showed a reduction in perinatal HIV transmission from 25.5% among HIV+ women who were not taking AZT to 8.3% in those who did.) 

Studies from both developed and developing countries have demonstrated a significant drop in the rate of serotransmission during heterosexual sexual activity when ARV treatment was used. However, many factors affect how effective ARV treatment is, including the prevalence and type of risk behaviors, compliance with treatment protocols, and when treatment is initiated. This suggests that treatment would be most effective as a preventive mechanism only when combined with early screening and behavioral changes.

While ARV use as prevention raises concerns about informed consent and the civil rights of HIV positive individuals, not to mention the other health-consequences of extended ARV use by those who may not clearly benefit from these drugs, this paper does embrace evidence of its potential to significantly reduce the rate of new transmissions. Given this and the individual benefits of ARV use, such as improved health and prolonged lifespan for most whose health status makes treatment clinically indicated, this document urges French policymakers to consider ways to improve testing options and availability of ARV to both improve the lives of seropositive individuals and reduce the spread of HIV.