The challenge of HIV control remains real. We have the tools to prevent transmission, but there is a real cost in deploying them, and in many regions, ongoing HIV-associated stigma and societal inattention to the epidemic remain significant barriers.
Although the root cause of the current outbreak in Pakistan is not yet reported, we do know that HIV in very young children must be due to infection in women giving birth or in parenteral exposure to HIV-contaminated needles and/or blood products. Either source can be successfully interrupted.
Universal testing of adolescents and adults, including women of childbearing age, should be established globally. Treatment of infected persons essentially is completely effective in preventing transmission, including to the fetus and newborns of infected women giving birth. Similarly, the blood supply can be protected by screening blood donors and referring those found to be infected into HIV care. Procedures to avoid reuse of needles and associated medical equipment are also straightforward and available, although again at a cost.
Earlier in the epidemic, an outbreak of HIV infections occurred in China due to poor transfusion practice and, more recently, in the Central United States through needle sharing during injection drug use. Both outbreaks were contained with public health interventions. It is hoped that the origin of the newly reported outbreak in Pakistan can be swiftly determined and resources applied to contain it as well. And more importantly, we would hope future avoidable transmissions can be prevented by using the knowledge, tools and experience that we now possess.
Paul A. Volberding, MD
Professor of medicine
Director, AIDS Research Institute
University of California, San Francisco
Disclosures: Volberding chairs a data management committee for a clinical trial run by Merck.