ARVs as prevention tool sparks debate

The recent controversial statement by Swiss researchers that HIV-positive people on treatment with an undetectable viral load could not infect their sexual partners was a hotly debated issue at the International AIDS Conference this week.

Delivering a presentation on the first day of the conference, Pietro Vernazza, president of the Swiss Federal Commission for HIV/AIDS (CFS) and the main author of the paper, said the findings gave hope, especially to discordant couples wanting to conceive.

He warned however, that while the findings were good news for some, they were unlikely to have global repercussions for HIV prevention. "This isn't advising people not to use condoms...and we want to be clear about the fact that it is the informed [HIV-negative] partner who should decide on the manner in which he/she wants to apply these findings to their daily life."

But Catherine Hankins, chief scientific adviser at UNAIDS, warned that the Swiss statement had "a large potential of doing more harm than good" - particularly in developing countries where many people living with the virus could not access viral load testing.

The CFS declaration has also provoked mixed reactions from activists involved in the fight against AIDS. Some, like the lobby group Act-Up, have advised caution. But Nikos Dedes of the European AIDS Treatment Group (EATG) said it was necessary to "draw positive lessons from this declaration".

Bernard Hirschel, one of the co-authors of the Swiss declaration, warned that scientists could not afford to waste time debating the issue and asking "for more evidence".

"The time it takes to obtain perfect evidence has a great cost," he said. "Remember that for circumcision, between good circumstantial evidence that it worked and the acceptance through a randomized controlled trial, 17 years elapsed."

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See also: GLOBAL: Treatment as prevention: the next frontier