Petrelis Files

Swiss Expert: AIDS Cocktail
Equals Prevention, Eradication & Vaccine

(One of the latest sexy eye-catching and non-fear based HIV prevention ads from the Swiss government's health office.)

A French-Swiss HIV expert generated much interest and debate last week among European activists on preventing and controlling AIDS after he spoke to the media explaining his theory that triple combination therapy could potentially be the answer to many vexing HIV questions, including what to do to stop AIDS since a vaccine is not an option.

Olivier Jablonsky, of the Paris-based radical activist health organization WARNING, tipped me off to a few of the stories and interviews with Dr. Bernard Hirschel, a leading researcher in global HIV/AIDS concerns.

His basic view, as I understand it, is that AIDS cocktails knock down the HIV viral load to undetectable or extremely low levels, making positive persons non-contagious. However, he also acknowledges there is still no zero risk of spreading new HIV infections, something to always keep in mind.

It seems Hirschel is proposing that if HIV positive people properly adhere to taking their AIDS medicines, reducing their viral loads to undetectable, and their ability to transmit the virus, the positive person won't pass on HIV even if that person doesn't practice safe sex.

And if HIV positive people are not further transmitting the virus, better control of the epidemic can be achieved.

If this is the case, then it means radical change will be necessary in designing effective prevention social marketing campaigns and the work of public health authorities everywhere.

Hirschel's provocative theories should foster lots of discussion among prevention organizations and activists. Indeed, there will be a public chat with Hirschel, sponsored by the Swiss gay group DialoGai, in Geneva on January 24, 2008.

Here are excerpts from Swiss news reports, roughly translated using Google. In the coming week, I trust and expect Dr. Hirschel's new ideas and supporting data will be better translated into English and circulated more widely. Let's debate his theories and their implications for fighting AIDS.

The Tribune de Geneve's story, gets the ball rolling:

Professor Hirschel says that if the virus became undetectable, the infected person is no longer contaminating.

This is good news, but it is cumbersome. In most patients infected with HIV, the triple therapy reduced the rate of HIV in the blood to become undetectable. Does it mean that these people are no longer contagious, even if they engage in unprotected sex? "Yes," replied Dr. Bernard Hirschel, unity HIV / AIDS to the University Hospital of Geneva. "No detectable virus, no infection." [...]

The specialist HIV / AIDS has sought further evidence of this safety. Empiriques essentially. "We tried to find, with our colleagues in other hospitals Swiss exceptions to the rule. Despite thousands of new infections since 1996, we have identified a single case possible Geneva, dating from 1997 transmission from a patient following a triple apparently effective. But we were unable to verify that its viremia was undetectable. "

Moreover, following the abandonment of condoms in certain populations, the number of sexually transmitted diseases (syphilis, chlamydias ...) has increased. But not the incidence of HIV, as shown by a study conducted among homosexuals in San Francisco. "The only plausible explanation for this paradox is once again the triple," says the Professor. "By reducing viral load, it helps prevent the spread of HIV. " [...]

From Hirschel's interview with the Le Temps newspaper on Friday:

Le Temps: The triple therapy is a means of prevention, you say. How it s'explique-t-il?

Bernard Hirschel: Current treatments, if properly followed, reduce the level of virus in the blood and secretions of the patient. But studies conducted since 1999 have shown that below a certain concentration of virus, no contamination occurs. It has been verified, including the birth of children of HIV-positive mothers and also by studying couples where one partner was infected. [...]

Q For instance?

A Today, we can tell a couple where one partner is HIV-positive treated with an undetectable level of virus they can have a child without having to worry about contamination of the non-infected partner. After taking a risk, we can forgo preventive treatment and costly collateral side effects if the person with whom took place in touch critical presents no viral load. These are practices which are already installed. Today, we can go further.

Q Provide information, for example?

A We are afraid to prevention specialists. They are afraid to scramble a simple message which has been proven: "never unprotected." But we must note that there are people who fail to apply this rule will absolutely. It may therefore be useful to qualify, offer additional options. After all, contraception is no less effective because it has a choice between the pill and the condom.

Q But what about in practice?

A We can begin by saying to people undergoing treatment that they are not a public danger. Psychologically, it's very heavy feeling bearer of a serious illness can be communicated to those you love. This causes a terrible isolation. If we can reassure them, it is worth it. Then the basic preventive message does not change: in a casual sexual contact, it is necessary to protect themselves. In most enduring relationships that may change strategies. This forces us to customize the preventive messages, which corresponds to the evolution of the disease, which is no longer with us an absolute calamity, but a difficult affection with which many people have learned to live.

Q You are not afraid to criticize you see in ten years to have opened the door to new risk behaviors?

A There is no reproach ever to a medical or politician had overestimated the risk while the penalty can be terrible if it minimizes. But we can not be paralyzed by it: a preventive message that magnifies all the risks and does not correspond to reality loses credibility and effectiveness. Look what happened at the beginning of the epidemic, with the kiss. At one point, it was decided that the kiss did not allow contamination. It was not safe to 100%. But the data were available were clearly in that direction. And the message Preventive remained credible and workable.

Q If people under treatment do not contaminate their partners, it means we have the means to virtually eliminate the disease.

A Theoretically, yes. A team from Vancouver, Canada, has modeled what would happen if we treated, in this town, all the people infected and not the 30% who have symptoms like today. This cost until 2020. But then, costs far more important would be avoided until 2050, when the disease had disappeared. The same team will attempt to increase the rate of pay at 50% and measure what happens. However, it is possible in a developed country, in a country as poor and low-medicalized, this strategy would encounter significant barriers.

Q In Switzerland, however, it is possible ...

A Indeed. It's an idea that deserves all the more to be seen than to have a vaccine within a reasonable time now seems excluded. However, it must be very carefully considered the ethical issues: the processing involves some unpleasant side effects. To advise people who have no symptoms, so it should be solid reasons. Some people would probably agree to deal to stop being contagious. But it seems not to force those who do not wish. It should be no doubt wait a little that the treatments will further improve. This is now happening. At that time, I think we should seriously consider this strategy.