Could treatment for HIV, if given at an earlier enough point in time, prevent it? Science Magazine‘s “2011 Breakthrough of the Year” suggests that HIV treatment could mean prevention. The study in question appeared in the August 11 New England Journal of Medicine (NEJM) and showed that giving antiviral medicines to HIV-infected people when their immune systems are still relatively healthy made them 96 percent less likely to transmit the virus to uninfected partners.
1,763 heterosexual couples from nine different countries (Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe) were enrolled in the study, which is summarized in Science Daily:
Each couple included one partner with HIV infection. The investigators randomly assigned each couple to either one of two study groups. In the first group, the HIV-infected partner immediately began taking a combination of three antiretroviral drugs. The participants infected with HIV were extensively counseled on the need to consistently take the medications as directed. Outstanding compliance resulted in the nearly complete suppression of HIV in the blood (viral load) of the treated study participants in group one. my emphasis
In the second group (the deferred group), the HIV-infected partners began antiretroviral therapy when their CD4+ T-cell levels — a key measure of immune system health — fell below 250 cells per cubic millimeter or an AIDS-related event occurred. The HIV-infected participants also were counseled on the need to strictly adhere to the treatment regimen.
While the NEJM study was originally set to end in 2015, an independent data review by the independent data and safety monitoring board (DSMB) discovered that, only one out of a total 28 cases of HIV infection among the previously uninfected partners had occurred among those couples in which the HIV-infected partner had begun immediate antiretroviral therapy. The DSMB accordingly decided to call for an immediate release of the study’s findings.
Myron Cohen, M.D., director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, led the study, which is also known as the HPTN 052 clinical trial.
Science Magazine chose the NEJM study as the “breakthrough of the year” because of its “profound implications for the future response to the AIDS epidemic.” The study was sponsored by the National Institute of Allergy and Infectious Diseases (NIAID); its director, Dr. Anthony S. Fauci, M.D., noted that, while “treatment as prevention is not going to solve the global HIV/AIDS problem,” it can “make a significant impact on the HIV/AIDS pandemic,” when used in combination with a number of other tools and strategies, namely,
“…knowing one’s HIV status through routine testing, proper and consistent condom use, behavioral modification, needle and syringe exchange programs for injection drug users, voluntary, medically supervised adult male circumcision, preventing mother-to-child transmission, and, under some circumstances, antiretroviral use among HIV-negative individuals.”
Dr. Fauci also said that these “proven prevention methods,” along with continued research to create a preventive HIV vaccine and female-controlled HIV prevention, could lead to something before thought unimaginable, “an AIDS-free generation.”
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