Yesterday in Geneva UNAIDS presented the new world report about AIDS: World AIDS Day report: Results, outlining some significant progress in the fight against AIDS in recent years. The report shows a reduction of more than 50% of the rate of new HIV infections in 25 countries with medium and low income, of which more than half in sub-Saharan Africa, the region most affected by HIV. To quote some numbers, since 2001 the rate of new infections has fallen by 73% in Malawi, 71% in Botswana, 68% in Namibia, 58% in Zambia, 50% in Zimbabwe e 41% in South Africa and Swaziland. In sub-Saharan Africa the deaths from AIDS-related diseases were also reduced by 32%, from 2005 to 2011, and the number of people on antiretroviral treatment has increased.

The higher success was perhaps that reached among children: 50% of the global reduction in the incidence of HIV infections happened indeed among the smaller ones, thanks to the vertical mother to child prevention programs. In particular in 6 countries in sub-Saharan Africa – Burundi, Kenya, Namibia, South Africa, Togo and Zambia – that number has decreased by 40% between 2009 and 2011.

Once again therefore the struggle against AIDS passes through the access to the antiretroviral therapy, effective drugs not only in the treatment but also in the prevention of the HIV transmission. Worldwide the number of people under treatment has increased of 63%, including pregnant women. However, there are still 6.8 million people who should benefit from therapy but do not have access to treatment.
1000 are the days missing to achieve the targets: zero new infections, zero discrimination, zero AIDS related deaths. Although we begin to see the results, the road to “Getting to Zero” is still long. The positive trends presented in this report show that, by supporting programs for the prevention and treatment of the HIV infection, it is possible to achieve a fast decline of the infection all over the world.

On the other hand, in 2006 Marazzi and his colleagues of the DREAM program had shown that, by administering the triple therapy to Mozambican women HIV+ during pregnancy, it was possible to reduce the viral load in blood and breast milk, with a vertical transmission rate at 6 months of 1.4%. Therefore it was proved that it was possible to achieve, even in countries with limited resources, the same results obtained in the Western world. In addition, African women could breastfeed safely, without the risk of transmitting the virus to their children through breast milk! These results were confirmed by studies conducted by the same group in the following years: the HAART is effective in reducing mother to child transmission of HIV during pregnancy, delivery and breastfeeding.

These are the findings of a study in 2010 published on the AIDS scientific journal: the transmission rate at 12 months was found to be of 2% among the children who were breastfed. Therapy for pregnant women in sub-Saharan Africa is therefore the strategy to stop the HIV epidemic. Not only: according to a very recent study, it is possible to intervene on the sexual transmission of the infection. These results have been achieved once again by the researchers of DREAM, starting off from the mathematical model of Granich.

Taking into account the data of the patients of the DREAM centers in Malawi and Mozambique and inserting it into a theoretical model, it was found that it would be possible to achieve a reduction of infectivity five times higher, from 1.6% to 0.3%. The use of the triple therapy would in fact allow to reduce the viral load and hence the infectivity of a sexually active individual. In this way the incidence would decrease from 7% to 2% in 2 years (reaching 1% in 20 years) with a reduction of the prevalence of 50% (from 12% to 6%).

Thus, ensuring access to the antiretroviral therapy to the entire HIV+ sub-Saharan population could be the possible effective strategy to defeat HIV/AIDS?

The researchers of DREAM say yes. This opinion is also shared by the Executive Director of UNAIDS, Michel Sidibé who, in occasion of the presentation of the new report declared that UNAIDS will commit in supporting those countries struggling against HIV to accelerate the access to testing and treatment. Test to all and immediate treatment: this is the winning strategy.