[The struggle against AIDS: between new paradigms and inertia].

Abstract

Recent statistics on the global HIV epidemic illustrate that HIV incidence continues to increase and provide stark reminders of the urgent need for new and more effective HIV prevention tools. The new paradigm of HIV prevention strategies consists on a biomedical approach including circumcision, vaginal microbicides, pre and post exposure prophylaxis and the treatment of the infected individual. The goal of the ARV therapy is to reach level of plasma HIV indetectability. At less than 20c/ml the risk of sexual transmission is equal to zero. A mathematical model shows that by universal testing associated with immediate therapy the epidemic could be driven towards elimination by the year 2020. It is anticipated that there will be substantial barriers to making biomedical HIV prevention tools available to individuals who are the highest risk of infection. Operationalizing biomedical approaches will require tight links between HIV testing and treatment programs, as HIV testing will be the common entry point for people to receive either biomedical prevention tools or treatment.