With so much room for things to go wrong, the rush to roll out male circumcision has perplexed most dispassionate observers. Yet similar doubts regarding treatment-as-prevention has gained detractors calling for a “a giant pause” in light of a few studies showing real world conditions at odds with clinical trial results.
The Journal of AIDS has published a paper casting doubt on the use of treatment as prevention. The accompanying editorial is one that never appeared in the context of male circumcision and a similar disparity in real world conditions amid the results of the African RCTs.
In an accompanying editorial, Dr Myron Cohen says that the results “demand a giant pause” and show that the ability of HIV treatment to reduce the risk of transmission outside the setting of clinical studies is uncertain.
Quote above, from the AIDSMAP article
image / flickr / genvessel / constant gardener
The distinction between the real world and clinical studies is key. It is also key to the conundrum of the three RCTs in support of male circumcision and the reality we have seen with higher rates of HIV among circumcised men in places like Swaziland and Losotho.
Wany L et al. HIV transmission among serodiscordant couples: a retrospective study of former plasma donors in Henan, China. J Acquir Immune Defic Syndr, 55: 232-38, 2010.
Cohen MS HIV treatment as prevention: to be or not to be? J Acquir Immune Defic Syndr, 55, 137-8, 2010.