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How to use antiretroviral therapy (ART) to prevent and treat HIV/AIDS is the most pressing question in HIV research, say Kevin M De Cock and colleagues at the WHO.
Recent research suggests early therapy may increase survival rates and improve both individual and public health. Indeed, there is little doubt that early ART can help prevent HIV/AIDS, say the authors.
But most people with HIV are diagnosed late with advanced disease — and it is the treatment of people already infected that may have the widest impact, they add.
How best to combine ART with other evidence-based prevention efforts also remains uncertain.
Some WHO scientists have suggested that annual universal voluntary HIV testing, followed by immediate ART, could reduce HIV incidence in southern Africa by 95 per cent within a decade. But there are significant challenges, say the authors, including research, funding, human rights, acceptability and the potential for drug resistance.
The WHO will organise a consultation in late 2009 to examine research priorities, operational considerations and ethical concerns for the use of ART for HIV prevention, say the authors. Firm evidence is needed before policy on this issue can be developed.