Abstract
Highly Active Antiretroviral Therapy (HAART) has transformed the nature of HIV/AIDS from an imminent death sentence to a chronic manageable condition. There is a growing interest in the potential impact of “treatment as prevention” — a notion that expanded coverage with HAART would substantially reduce morbidity and mortality from HIV, and secondarily HIV transmission at the population level. However, undiagnosed and undocumented HIV cases cannot benefit from HAART and are more likely to experience HIV-related morbidity and untimely mortality. Late diagnosis of HIV remains prevalent and represents missed opportunities for early linkage to and engagement in care. In the absence of a vaccine and cure for HIV, undiagnosed HIV cases represent the biggest challenge yet in the fight against HIV/AIDS. As such, identifying them should be a priority of HIV prevention programs.
Key Words: HIV, Acquired Immunodeficiency Syndrome, undiagnosed HIV cases, early HIV detection, linkage to care, treatment and prevention
Résumé
La thérapie antirétrovirale hautement active (TAHA) a transformé le VIH et le sida de sentences de mort imminente en états chroniques gérables. On s’intéresse de plus en plus à l’impact potentiel du «traitement à titre préventif» — la notion voulant qu’une couverture élargie de la TAHA réduise considérablement la morbidité et la mortalité dues au VIH, et de façon secondaire la transmission du VIH dans la population. Toutefois, les cas de VIH non diagnostiqués et non documentés ne peuvent pas tirer parti de la TAHA et sont plus susceptibles de souffrir de morbidité et de mortalité prématurée liées au VIH. Le diagnostic tardif du VIH est encore prévalent et représente des occasions manquées d’aiguiller les patients et de les faire participer aux soins dès le début de la maladie. En l’absence d’un vaccin et d’un remède contre le VIH, les cas de VIH non diagnostiqués représentent le plus grand défi à ce jour dans la lutte contre le VIH et le sida. Identifier ces cas devrait donc être une priorité des programmes de prévention du VIH.
Mots Clés: VIH, syndrome d’immunodéficience acquise, cas de VIH non diagnostiqués, détection précoce du VIH, lien vers les soins, traitement et prévention
Footnotes
Acknowledgements of sources of support: Oghenowede Eyawo is supported by a Canadian Institutes of Health Research (CIHR) Doctoral Award. Dr. Robert Hogg has held grant funding in the last five years from the National Institutes of Health, CIHR, Health Canada, Merck, and the Social Sciences and Humanities Research Council of Canada. Dr. Hogg is a member of the STOP HIV/AIDS Study Group. Dr. Julio Montaner is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute of Drug Abuse (NIDA), at the US National Institutes of Health (NIH). He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), UNICEF, the University of British Columbia, Simon Fraser University, Providence Health Care and Vancouver Coastal Health Authority. He has received grants from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck and ViiV Healthcare; Dr. Montaner is a member of the STOP HIV/AIDS Study Group.
Conflict of Interest: None to declare.
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