The Swiss Statement (French: ''La déclaration suisse''; known in German as ''das EKAF-Statement''), or the Swiss Consensus Statement, was an announcement published in January 2008 by the Swiss Federal Commission for
AIDS/HIV
Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual m ...
(EKAF, ''Eidgenössischen Kommission für Aids-Fragen'') outlining the conditions under which an HIV-positive individual could be considered functionally noncontagious—namely, adherence to antiretroviral therapy, a sufficiently low
viral load
Viral load, also known as viral burden, is a numerical expression of the quantity of virus in a given volume of fluid, including biological and environmental specimens. It is not to be confused with viral titre or viral titer, which depends on the ...
, and a lack of any other sexually transmitted diseases. While lacking the backing of complete, fully randomized clinical studies, the Commission felt the contemporary evidence for non-contagiousness for people on antiretroviral treatment was nonetheless strong enough to warrant official publication.
The Statement generated significant controversy, with some defending it as based on adequate existing scientific evidence and as beneficial for people with HIV, and others maintaining that it was misleading and possibly encouraged risky sexual practices.
In the years following its publication, further studies validated the Statement. The Statement now represents a medical consensus on the transmission of HIV.
Background
Ongoing clinical research on serodiscordant couples (i.e. those with different HIV status) in the mid-2000s had produced evidence that
antiretroviral therapy
The management of HIV/AIDS normally includes the use of multiple Antiviral drug, antiretroviral drugs as a strategy to control HIV/AIDS, HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life- ...
(ART) regimes could be sufficient to suppress HIV viral load such that ART patients would not transmit the disease, even without practicing safe sex.
Statement and controversy
The statement listed three specific conditions under which an HIV-positive individual can be considered noncontagious to an HIV-negative sexual partner. These conditions are:
:"(1) the HIV-infected patient is receiving antiretroviral therapy with excellent adherence;
:(2) blood viral load has consistently been undetectable (<40 copies per mL
measure of viral loadfor more than 6 months); and
:(3) no STDs are present in either of the partners."
The statement generated controversy among the medical community; while not representing completely novel research, many were concerned with the implications for public health at large, as it might imply condoms were unnecessary. Concerns were also raised that blood-based measures of HIV viral concentrations might not reflect actual viral counts in semen, a view that Vernazza said that EKAF took into account when crafting the statement.
In response to the Swiss Statement, both the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
and the United States
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
reiterated their recommendations that condoms should always be used by HIV-positive individuals during sex.
Dr.
Anthony Fauci
Anthony Stephen Fauci (; born December 24, 1940) is an American physician-scientist and immunologist serving as the director of the National Institute of Allergy and Infectious Diseases (NIAID) and the chief medical advisor to the president. ...
, then-director of the US National Institute of Health's Institute of Allergy and Infectious Diseases, noted that "
e phenomenon of lower virus, less chance of transmission is well known," but that he and other health authorities were still concerned with "making the statement that there is essentially no risk of getting infected if you are having sex with a partner who is HIV-positive and on ARVs
ntiretroviralswith virus below detectable levels. There is no such thing as zero risk."
Research by Wilson et al. published later in 2008 argued that while the risk of HIV transmission was very low among heterosexual couples meeting the three conditions of the Swiss Statement, it was still non-zero. Based on mathematical modeling of 10,000 hypothetical heterosexual,
serodiscordant
A serodiscordant relationship, also known as mixed-status, is one where one partner is infected by HIV and the other is not. This contrasts with seroconcordant relationships, in which both partners are of the same HIV status. Serodiscordancy contri ...
couples, risk of HIV transmission could be as high as 60% per year; for homosexual partnerships, the rate could be even higher. Thus, they argued, "If the claim of non-infectiousness in effectively treated patients was widely accepted, and condom use subsequently declined, then there is the potential for substantial increases in HIV incidence." Vernazza et al., the authors of the Swiss Statement, countered that the modeled 60% chance of infection did not comport with any available empirical data and that condom use had a similar rate of transmission in the Wilson et al. study.
Further developments
The findings of the Swiss Statement became scientific consensus in the 2010s. The
HPTN 052 HPTN 052 is the name of a clinical trial conducted in nine countries which examined whether starting people living with HIV on antiretroviral therapy (ART) can reduce the chance that they will pass HIV on to their sexual partners who do not have HIV ...
study published in 2011 and the PARTNER study published in 2014 further validated the Statement's argument.
See also
*
Treatment as prevention
Treatment as prevention (TasP) is a concept in public health that promotes treatment as a way to prevent and reduce the likelihood of HIV illness, death and transmission from an infected individual to others. Expanding access to earlier HIV diagn ...
*
HPTN 052 HPTN 052 is the name of a clinical trial conducted in nine countries which examined whether starting people living with HIV on antiretroviral therapy (ART) can reduce the chance that they will pass HIV on to their sexual partners who do not have HIV ...
Notes
References
{{reflist
External links
* Th
original Swiss Statement(in French)
* Unofficia
English translation
HIV/AIDS
HIV/AIDS research
Prevention of HIV/AIDS
History of HIV/AIDS