U.S. gov says HIV meds cut infections by 96%
The National Institutes of Health in Washington, D.C., announced Thursday that a study of the impact of anti-retroviral medications on the infectiousness of those infected with the virus found the medications cut infections by 96 percent.
The study confirmed a determination by the Swiss High Court several years ago. The court there ruled that a person on HIV medications that have achieved an undetectable viral load for six months or more and were not infected with any other sexually transmitted infections were not legally contagious.
In this new study, researchers follow 1,763 couples in 13 study locations in the Americas, Africa and Asia. The couples were sero-discordant — or magnetic couples — which means one partner was HIV-positive and the other was HIV-negative. Couples were randomly assigned into two study groups. In the first group, the HIV-positive partner received HIV medications only when their blood work showed the virus was beginning to do damage to the immune system. In the second group, the HIV-positive partner was started on medications immediately, regardless of what blood tests show.
The second group was found to reduce infections by 96 percent, reports the BBC. The group where the medications were started immediately saw only one seroconversion, while the other group saw 27 seroconversions. The study findings were so dramatic, NIH researchers pulled the plug on the program four years early in order to extend the medication intervention to all of the couples and prevent new infections. The study started in 2005 was supposed to last until 2015.
The study is likely to fuel the continued push by the Centers for Disease Control and Prevention in Atlanta for a prevention strategy called “test and treat.” In that strategy, health workers work to identify all people infected with the virus in high prevalence areas. As soon as someone tests positive for HIV, they are started on anti-retrovirals. The CDC is currently piloting the idea in Washington D.C. and Brooklyn NY, two areas with significant HIV prevalence.
Targeting viral loads, which is a measure of free virus in the blood, in order to reduce it has long been a goal in treating HIV. However, it has also begun to show promise as a prevention intervention as well. However, it is not without detractors.
Some people argue that the medications are being foisted on HIV-positive individuals who may not fully understand the implications of taking the toxic meds for the rest of their lives. They may also not feel empowered to challenge health care providers and become full partners in their own care. The final concern that is expressed about test and treat is the issue of medical necessity. There are no long term studies showing what, if any, benefit taking the medications early in the infection course may have over the long term effects of the medications themselves.
Regardless of those concerns, prevention advocates hailed the discovery, reports the Chicago Tribune.
“This is amazing news,” said Michael Sidibe, executive director of the Joint United Nations Programme on HIV/AIDS. “Prevention can be a reality. The science is strong — so strong that we must use it.”
Using those medications right away may be an issue, since the medication can run $15,000 or more per year. Developing countries continue to struggle to afford the anti-HIV medications, even when they have access to cheaper generics. And here in the U.S. the federally funded AIDS Drug Assistance Program has been under strain across the country. The strain has resulted from more people starting treatment sooner as the result of a 2009 change in treatment protocols as well as the economic pressures of increased unemployment and stagnant wages.