Views & Reviews Personal View

As with tuberculosis, earlier identification and treatment is the way to tackle HIV

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2874 (Published 27 April 2012) Cite this as: BMJ 2012;344:e2874
  1. Philip Mortimer, retired virologist, Oxford
  1. pandjmortimer{at}gmail.com

After 30 years and thousands of scientific papers published on AIDS and its virus, can we see the wood for the trees? Would earlier diagnosis and treatment, by interrupting HIV transmission and limiting its rising incidence, better control its spread and ultimately reduce costs?

Analogies sometimes help. Even before HIV had been discovered AIDS was being compared with chronic hepatitis B. The groups at risk and the routes of transmission were similar, and in both infections a carrier state eventually led to the exhaustion of the target tissue. HIV has, however, proved itself unlike hepatitis B virus—it has continued to resist attempts to develop a vaccine against it, but is much more susceptible to antiviral treatment.

With the drug treatment of HIV now offering such promise, a better analogy lies in the conquest of tuberculosis by combined drug treatment in the 1950s. The stigma that attached to tuberculosis might have allowed case finding and contact tracing to be deemed too difficult, but it was generally accepted that intensified measures to find cases of active tuberculosis were justified …

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