People infected with HIV/AIDS are overwhelmingly less likely to pass on the virus to their partners if they start taking antiretroviral medicines immediately after diagnosis, when their immune systems are relatively healthy, according to a new study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
Michel Sidibe, executive director of UNAIDS called the study a “game-changer” that “will drive the prevention revolution forward.” The study showed a 96.3% reduction in transmission from infected partner to uninfected partner.
“This new finding convincingly demonstrates that treating the infected individual — and doing so sooner rather than later — can have a major impact on reducing HIV transmission,” NIAID director Dr. Anthony Fauci, said in a statement.
The finding is so significant that, as the New York Times noted,
it is likely to change the way American AIDS doctors treat patients and what treatment policies are adopted by the World Health Organization and other countries.
The international study, which looked at 1,763 mostly heterosexual couples in Africa, Asia and the Americas, launched in 2005. It was meant to last 10 years, but the results were so striking the investigators stopped it midway through and recommended the course of drug therapy be offered to all the study’s participants. The investigators wanted to include more men in the study but “they just weren’t interested,” according to Dr. Myron Cohen, an AIDS specialist from the University of North Carolina, Chapel Hill and director of the study.
In all cases, one partner had tested positive for the virus that causes HIV/AIDS, while the other was not. In half the couples, selected at random, the infected partner was put on an immediate course of antiretroviral drugs. In the other half, the infected partner had to wait until his or her CD4 count dropped below 250 per cubic milliliter. (The CD4 count is a crucial measure of the immune system — normal counts run between 500 and 1,500).
As the New York Times reported:
The results carry moral implications for doctors in the United States. Although medical associations like the Infectious Diseases Society of America advocate starting patients on AIDS drugs early, the decision is made by the doctor and patient. Some patients fear the reported side effects of AIDS drugs and want to delay taking the drugs until they get obviously sick or until their CD4 counts fall, and some doctors go along with that, Dr. Fauci said, especially as long as their patients’ CD4 counts remain above 350.
But that means the patient may infect others during the delay. Of the 27 people in the study who became infected while their partners were not yet taking the drugs, 17 had partners whose CD4 counts were still above 350.
Asked if it could now be considered immoral for a doctor to accede to a patient’s request to delay starting drugs, Dr. Fauci said: “I’m not going to go there. I’m not going to say it’s immoral. But there is more and more data showing the advantages of starting as early as you can.”
Access to the medications — especially in poor countries — is a very real consideration as well, as MSNBC pointed out:
Already — for financial reasons — only a small percentage of people who need the drugs to save their lives get them. Expanding the use for the prevention of transmission raises the same issues of access to the drugs.
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