Sat, 22 Feb 2003

Curbing the spread of HIV

Although it may have been well-meant, Chris Green's article in The Jakarta Post on Feb. 19, 2003, titled AIDS can be treated! Don't get it wrong makes some assertions that should not go without comment.

First, under certain circumstances, treatment for HIV should be commenced before the onset of AIDS. One obvious case is when treating to prevent mother-to-child transmission, where the benefit to the unborn child from treating an HIV-positive pregnant woman -- who has not developed AIDS -- is well proven.

But more than this, it is not at all clear that AIDS patients benefit more from antiretroviral treatment than those newly infected with HIV. In fact, recent expert opinion advocates that the best time for aggressive therapy is when the viral load, which is the quantity of the virus in the patient's blood, is low. This corresponds to the period early in the infection and not at the onset of AIDS, when the viral load is typically high. Early treatment, it is said, effectively weakens the virus, giving it less opportunity to take hold while at the same time, improving the patient's own immune system the capacity to fight the infection.

I was also alarmed to read about the plight of Sulasi, who has to contend with the lack of specialist medical care in Malang. While medical practitioners who care for patients like Sulasi should be highly commended, HIV infection is a complex disease requiring regular expert intervention if it is to be properly managed.

Specialist education for such doctors should therefore be a high priority for any government aiming to curb the spread of HIV.