To the Editor: In their Commentary, Drs Dieffenbach and Fauci1 examined the untested assumptions and implications of the “test and treat” human immunodeficiency virus (HIV) prevention strategy modeled in the study by Granich et al.2 I believe that the Commentary did not address several points relevant to considering this strategy for the United States.
First, the study by Granich et al compared a particular intervention strategy (universal annual testing and immediate HIV treatment) with the absence of that strategy.2 Because many HIV prevention strategies are effective and cost-effective, it is important to identify those intervention options that will most rapidly influence the course of the epidemic. Mathematical models are likely to provide more policy guidance if a variety of intervention strategies are compared with each other.
Second, while the model in Granich et al focused on South Africa, some relevant information about the effect of such a strategy in the United States may be found in other studies. The Centers for Disease Control and Prevention has estimated that approximately 30% to 46% of the US cases of sexual transmission of HIV are from persons aware of their HIV seropositivity (assuming a 60% level of treatment and that 54.5% of persons in treatment have a viral load of less than 500 copies/mL).3 In the United States, perfect awareness of HIV seropositivity would be estimated to decrease HIV incidence by no more than approximately 40%.4
Third, a recent estimate of the US annual HIV transmission rate5 found that since 1991 the only increase in the transmission rate was in 1997, just after the advent of highly active antiretroviral therapy (ART). This suggests that the national effect of treatment availability is likely a complex function of biological, clinical, behavioral, and social factors.
Given these challenges, the Granich et al model may not be the optimal framework to guide the National Institutes of Health HIV prevention agenda.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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