Wednesday, November 26, 2008

The Mathematics of HIV Infection

A new mathematical model suggests that the HIV virus could be virtually eliminated in 10 years if every person in every country with high infection rates was tested and treated.

Published in "The Lancet", the study is indeed intriguing, and the World Health Organization promises to examine the findings more closely. The model includes voluntary testing of every citizen, with AIDS drugs prescribed for any patient testing positive for the HIV virus, regardless of whether they are symptomatic or not. (Current practices often dictate withholding treatment until a patient has symptoms, or when their T-cells---immune cells that fight opportunistic infection---fall below a certain level.)

At this time, the price tag for such a strategy is estimated at $3.4 billion per year initially, with costs decreasing over time.

With approximately 33 million people infected with HIV worldwide, increased testing and treatment would, of course, cost money. However, an already overwhelmed healthcare infrastructure in places like sub-Saharan Africa (where HIV rates are still rising) would pose significant logistical challenges. (For an interesting map detailing the number of HIV cases and AIDS deaths worldwide, please click here.) How those countries would be financially and logistically supported by the global community in implementing such a strategy remains to be seen.

From a human rights perspective, critics of such an approach feel that universal testing and treatment might infringe on individual rights. And as many patients with HIV and AIDS already know, taking antiretrovirals is not easy, and side effects such as liver toxicity or failure, heart attacks and kidney failure are all relatively common.

Such studies and models for a plausible expansion of the global effort against HIV and AIDS are laudable, and perhaps the AIDS epidemic will indeed be significantly curtailed in the decades to come. Perhaps the greatest gift that we could give to the children of the 22nd century would be to eradicate HIV and AIDS from the face of the earth in the current century, a goal that has generally been seen as virtually impossible until now.

Some nay-sayers may feel that we're getting ahead of ourselves as infection rates steadily rise in Russia and other countries, but there are scientists and researchers around the globe seeing the possibilities of near-complete eradication. One can only hope that plausibility will eventually give way to reality, and someday we will truly look back on the epidemic as a disturbing yet finite piece of post-modern medical and societal history.
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