Treatment of HIV-infected Individuals to Prevent Transmission

The interim results of the HPTN 052 study released last week indicate that treating HIV-infected individuals dramatically reduces the likelihood that they will transmit the virus to their sexual partners.  This study of HIV-positive patients whose heterosexual partners were HIV-negative and whose disease was at a stage at which treatment would be considered optional showed a dramatic decrease in transmission to their sexual partners for those treated immediately and was stopped early due to the results.

This study raises some interesting ethical questions.

Are HIV-positive persons who have an unaffected partner now obligated to undergo treatment even if there is not evidence that the benefit of the treatment outweighs the adverse effects for the individual?

If treatment of infected persons is an effective means of preventing the spread of HIV, how aggressive should those responsible for public health be in seeking to identify and treat those with HIV?

What should be done in countries with a high level of HIV that already cannot afford antiretroviral treatment for the more severely affected?  If treatment of all infected people would dramatically reduce the incidence of new cases in those countries where do we get the resources to provide that treatment?

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