FROM THE DIRECTOR

HIV Research Lights the Way to Better Prevention and Care

Annette Sohn, M.D.

October 2010—Some of the most critical questions about optimizing HIV/AIDS prevention and clinical care are being answered by research that is being conducted in resource-limited settings where the epidemic strikes hardest. Results from the widely publicized CAPRISA 004 trial, carried out in South Africa by South African investigators, were presented in July and demonstrated that a microbicide gel can successfully reduce HIV infections among women. Another key study, conducted in Haiti, led to a recent change in World Health Organization (WHO) guidelines for when to start antiretroviral therapy (ART) in adults in resource-limited settings. (This clinical trial showed that starting treatment at a higher CD4 level led to a 75 percent reduction in the rate of death, compared to the previous WHO CD4 threshold. In 2008, another study out of South Africa, the CHER trial, achieved a similar reduction in mortality with early infant treatment and also led to changes in the WHO pediatric guidelines.

Despite these recent studies and their impact on global HIV treatment guidelines, research alone cannot save lives. Only when research is put into practice can it have its full impact. If the 2010 WHO guidelines for children, pregnant women, and other adults are not rapidly implemented by national governments, the potential benefits of recent studies will be lost. But this is easier said than done. Shifting treatment thresholds and expanding the number of people on ART in Asia and around the world will require an intensified commitment to scaling up treatment access. National governments in low- and middle-income countries are under greater pressure to increase their own healthcare expenditures, but this will not obviate the need for ongoing international funding support.

As HIV research continues to light the way to better care and prevention, it is local and global leadership on health policy and community advocacy that will put the progress of the scientific and medical communities into practice.

      — Annette Sohn, M.D.