What We're Reading: HIV Treatment as Prevention
Posted by
Robert Yule
Washington, D.C.
May 16, 2011
Last week, we were reading several articles about a “
groundbreaking” and “
landmark” new AIDS study involving both treatment and prevention of HIV.
The HPTN 052 study used HIV treatment as a means of preventing sexual transmission of the virus within couples where one partner is HIV-positive, and the other is HIV-negative.
Individuals were given antiretroviral treatment (ART) as soon as they tested positive for HIV, even if they did not yet show symptoms of a compromised immune system.
Known as “treatment as prevention,” this method was shown to reduce the likelihood of transmitting the virus by an overwhelming 96%.
The HIV-positive individuals in the study were started on ART when their CD4 count – which tells the strength of the immune system – was measured between 350 and 550. Most national guidelines for resource-poor countries don’t call for ART to be started until a person’s immune system is even weaker, with a CD4 count under 350.
In a statement, WHO Director-General Dr. Margaret Chan said, “This is a crucial development, because we know that sexual transmission accounts for about 80% of all new infections.”
The website IRIN PlusNews reported that while there have been other studies that showed similar results, this is the first major randomized clinical trial to confirm these findings: HIV-positive people with an undetectable viral load are much less likely to transmit HIV to others.
According to the Washington Post, “The study provides evidence – useful in American cities and African villages – that getting HIV-infected people on treatment early, long before they have symptoms, may be the best strategy for slowing the 30-year-old epidemic.”
Funded by the U.S. National Institutes of Health (NIH), the HPTN 052 study was started in 2005, and involved mostly heterosexual couples in the following countries: Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the U.S., and Zimbabwe. It was scheduled to continue through 2015, but was stopped early because of its dramatic results.
Michel Sidibé, Executive Director of UNAIDS,
said in a statement: “This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option.”
The New York Times reported on the potential difficulties of implementing a treatment as prevention strategy, both in Africa and in the U.S.: “Although the evidence suggests that it would be good public health policy to lower infection rates by starting everyone on drugs as soon as they are infected, that is impossible in much of the world. For lack of money, clinics in Africa are turning away patients who are not just infected but close to death. And in some American states where money provided by the Ryan White Care Act has run out, poor uninsured people are on waiting lists.”
Dr. Anthony Fauci, the Director of NIH’s National Institute of Allergy and Infectious Diseases, spoke to the
Wall Street Journal about the importance of this new study, as well as the need for continued research, such as the development of an HIV vaccine.
Dr. Fauci also described another way to make a dent in new global HIV infections, called “combination prevention” – using a number of existing prevention methods, such as male circumcision and microbicide gels for women, along with practices like the use of condoms and limiting sexual partners.
It’s clear that the implications of this study will continue to be in the news in the weeks and months to come.
Robert Yule is the Foundation’s Senior Media Relations Manager, based in Washington, D.C.