With the adoption of the test and treat policy – where a person is put on treatment immediately after testing positive, irrespective of their CD4 count – the number of people on ARVs is expected to multiply. “In South Africa, we have to focus on treatment and prevention. If we focus on our pre-exposure prophylaxis [PrEP] to prevent infection in key populations, including young women, we could have a greater effect [on HIV prevention],” said Bekker. “We must increase our focus on prevention in young women because of their ability to transmit to others.” Last year, the Centre for the Aids Programme of Research in SA released a study that showed how HIV moves from an older woman to an older man, who then infects a young girl. The girl grows up, becomes a young woman and then starts dating men her age, whom she then infects. Bekker was referring to this cycle when she said young women’s ability to transmit to others was concerning. “Oral PrEP is part of the prevention option today ... and is ready for deployment. The benefit of PrEP lies in avoiding 260 000 infections among young South Africans. This outweighs the risks,” Bekker said. South Africa approved the use of PrEP last year in certain high-risk populations, including among sex workers and men who have sex with men. Currently, 1 300 people are taking PrEP in 17 pilot sites countrywide. Scientists and policymakers said that, while PrEP offered an effective way of preventing HIV infection in South Africa, it was not a magic bullet. Several vaccine trials are taking place worldwide and South Africa is one of the countries at the forefront of this research.
Currently, two trials – the vaccine efficacy trial known as HVTN 702 and the AMP study – are under way.
Professor Penny Moore, the research chair of VirusHost Dynamics at the University of the Witwatersrand and the National Institute for Communicable Diseases, said the AMP study – which seeks to find out if cloning broadly neutralising antibodies can prevent HIV infection – was currently enrolling volunteers.
Scientists working on the AMP study plan to recruit 4 200 people, of which 1 500 will be women living in sub-Saharan Africa at high risk of acquiring HIV.
Professor Thumbi Ndung’u, research group leader at the Africa Health Research Institute, said South Africa, like the rest of the world, needed a cure for HIV, but finding one would not be easy. He cited the evolving nature of the HI virus and its ability to hide as the biggest obstacles to flushing HIV out of the human system.
He mentioned several methods tried over the years, without success. These included stem cell transplants, done to eliminate HIV from patients’ immune systems. The so-called functional cure was also tried on HIVpositive people – this refers to stopping HIV treatment and allowing the body to naturally control the virus.
Ndung’u said even the stem cell transplant, which had worked for Timothy Brown – the first person to be cured of HIV – was not viable “because it was expensive and could not be introduced on a large scale”. In 2006, Brown found out he had leukaemia. He received two stem cell transplants to treat his cancer and rebuild his immune system – in the process, killing off his HIV.
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