Universal voluntary HIV testing and immediate antiretroviral therapy.

摘要

Reuben Granich and colleagues1 suggest universal HIV testing and immediate treatment of those found positive, which is indeed "a bold move away from the current approach of treatment on the basis of clinical need and prevention through behavioural education. Granich and colleagues' modelling results depend heavily on the validity of assumptions about future or unrealised events. For example, they assume that, with treatment, infectiousness fell to only 1% of untreated infectiousness. They also assume a yearly dropout rate of 1-5%, which would seem overly optimistic for a long-term "universal" programme. A sensitivity analysis with these model parameters would have allowed us to see how different values might affect the results qualitatively. Scientifically, their results merely indicate some possible future scenarios-if antiretroviral therapy strikingly lowers the infectivity of treated patients, if long-term compliance is sufficiently high, and if this programme does not lead to significantly more risky behaviour by the population owing to a false sense of security.