Early treatment of HIV makes infection transmission less likely: Study

By Dr. Ananya Mandal, MDMay 15 2011

According to a new study among couples, early use of drugs slashed the risk of HIV infection through sex by 96 per cent.

“It's a game-changer,” Michel Sidibe, executive director of UNAIDS, said. “I am completely amazed.” It was noted that anti-HIV drugs called antiretroviral drugs can suppress HIV in an infected patient and also help to prevent its spread through intercourse, he said. He predicted a rethink of the strategies that have evolved since the first cases of AIDS were recorded in June 1981. “The implications are multiple,” said Mr Sidibe. “However, money will be the major challenge.”

For starters the tasks include encouraging HIV testing and administering early treatment to people with the virus, especially in at-risk population niches such as gay men, intravenous drug users and sex workers, he said.

Margaret Chan, director general of the UN's World Health Organisation, added that the study was “a crucial development”. “The findings from this study will further strengthen and support the new guidance that WHO is releasing in July to help people living with HIV protect their partners,” Dr Chan said.

In January 2008 by a Swiss researcher, Bernard Hirschel ventured that someone who had observed a drug regimen and was shown to have suppressed the virus in his or her blood was no longer an infection risk through sex. Some activists scorned the findings as premature or even irresponsible.

But vindication came today with data from the first randomised clinical trial, carried out among “discordant” couples, one of whom had the virus while the other was HIV-negative. The study enrolled 1,763 couples in 13 sites in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the U.S., and Zimbabwe. Each couple had one partner who was uninfected and another who was infected with HIV and had a CD4 count of 350 to 500. 97 per cent were heterosexual.

In the first group, the HIV-positive partner received anti-HIV drugs immediately; in the second, the HIV-positive partner deferred treatment until he or she had reached a given level of viral infection. The US National Institutes of Health reported when an HIV-infected partner began immediate antiretroviral treatment and adhered to it, there was a 96-per cent fall in HIV transmission.

Jean-Francois Delfraissy, director of France's National Agency for AIDS Research (ANRS), described the study as “a really important moment for public health”. Professor Delfraissy however added that this should not make heterosexual couples negligent about their sexual behaviour. “It's one more argument for stopping the epidemic by treating all HIV-positive people so that they do not transmit the virus,” commented Bruno Spire of the French advocacy group Aides. “It's marvellous news... another piece of evidence to favour using treatment as prevention,” said Francoise Barre-Sinoussi, part of the French team that won the Nobel prize for identifying HIV.

Each day, more than 7,000 people are newly infected with HIV, including 1,000 children. AIDS has claimed more than 25 million lives and more than 60 million people have become infected since the disease was first recorded in 1981. Around 80 percent of new infections occur through sex, according to UN figures.

In addition, Professor Delfraissy observed, “there aren't the means to treat everyone”. The UN has set a target of zero new infections by 2015. By that time, 13 million people, according to current clinical guidelines, will need drugs; at present, only six million have access to them.

AVAC, a New York-based group for HIV prevention, added that the study highlighted the success of the revolutionary drugs that emerged in the mid-1990s and are now a lifeline for millions.