Dr. Anthony Fauci’s Speech & Pathogenesis

“No matter how you slice & dice, data are significant… we still have work ahead.” -Anthony Fauci at #AIDS2010

During Tuesday’s plenary session, Anthony Fauci took the audience through the complex but intriguing mechanisms of HIV pathogenesis. It was not a lecture only for expert immunologists, since he combined the recent scientific developments and knowledge of these mechanisms in a captivating way. The early events following HIV exposure are among the most crucial in determining the occurrence of the HIV infection and the pace of viral dissemination and transition from infection to disease.

It was interesting to hear that even if antiretroviral treatment is initiated when the primary infection symptoms are evident, the virus can still produce a reservoir of infected cells that makes its eradication impossible. At the same time, the pathogenetic path has shown how important post-exposure prophylaxis (PEP) can be for someone immediately after being exposed to the HIV virus.

This poses a serious question for all of us working in HIV&AIDS-related projects across African countries. It is rare to find a clear policy on professional PEP, and even when policy is in place, its implementation is patchy to say the least. Health workers in program-supported facilities get exposed to possible infection, but data are scanty (no directory of professional incidents is being compiled); ARVs may not be easily available for any use other than treating registered patients; and a sense of resignation about the occurrence of these incidents is common among health staff. While the PEP strategy is being gradually expanded for post-rape survivors, it is paramount to provide it for health workers even in remote facilities with no ARV provision. This practice should be aligned with a sound policy of protection of health workers and may eventually transmit a feeling of confidence among those staff involved in risky medical procedures.

And additionally… it would not be bad to include immunization with hepatitis B (HBV) vaccine, which by now seems to be available only for children, but out of the reach of health workers in areas known to experience a relatively high prevalence of HBV.

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