Scientists discover (again): AIDS treatment prevents infection

Flickr, Benny Sølz

As MSNBC, the Wall Street Journal, New York Times and many other media report today:

People infected with the virus that causes AIDS are far less likely to infect their sexual partners if they are put on treatment immediately instead of waiting until their immune systems begin to deteriorate, scientists report.

The study, begun in 2005, was done by the National Institutes of Health and had such dramatically positive results it was ended five years early. As the Wall Street Journal’s Mark Schoofs writes:

The results were so overwhelming that an independent panel monitoring the research recommended the results be released four years before the large, multi-country study had been scheduled to end.

 

Connie Celum

What may be even more surprising is that a Seattle-based AIDS expert, Connie Celum, as well as some Swiss scientists had already discovered this!

Here’s my post on Celum’s findings last July, UW Study shows AIDS Treatment IS Prevention. As Celum and her team reported back then in The Lancet:

“We found a 92 percent reduction in transmission among those who went on (anti-HIV drug therapy),” said Celum.

The New York Times said the NIH study was convincing because it is the first time this was shown in a major randomized clinical trial and earlier studies had only “implied” this. That’s a little misleading and certainly ignores the power of what Celum and her colleagues showed.

The UW team studied 3,400 couples in seven African countries (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia) and followed 349 couples for two years after the HIV-infected partner started taking the drugs. Those who remained on the medication therapy reduced their chances of passing on HIV to the sexual partner by 92 percent — pretty much what NIH found.

In 2008, when some Swiss scientists first suggested this idea based on a number of studies they believed clearly showed that treatment actually is prevention many American AIDS experts dismissed the notion, one even calling it “dangerous.”

“Not only is [the Swiss proposal]dangerous, it’s misleading and it is not considering the implications of the biological facts involved with HIV transmission,” said Dr. Jay Levy, director of the Laboratory for Tumor and AIDS Virus Research at the University of California in San Francisco and one of the co-discoverers of HIV.

This finding/confirmation that treating people with HIV is highly effective at preventing the spread of AIDS has profound implications for AIDS care in the U.S. but also for global health.

  • First, it gets round the whole prevention vs. treatment debate — since they now accomplish the same thing.
  • Secondly, it implies that the best strategy for battling the HIV pandemic in lieu of an effective AIDS vaccine is to aggressively identify all of those infected and get them on treatment as soon as possible.

Some experts believe the HIV pandemic — which continues to newly infect millions of people and costs the international community tens of billions of dollars today — could be brought to heel in five years if those at risk were aggressively tested and treated.

Standard procedure for starting anti-HIV drugs is based on when the blood level of an immune cell targeted by HIV, known as the CD4 cell, drops below a certain threshold. In most African countries, that threshold is a CD4 count of 200 or lower (normal being from 500 to 1,000). Now, it looks like drug therapy should begin as soon as HIV is detected.

As Celum told me today: “Maybe this will be the final piece of data to stimulate policymakers to take note and push for more resources.”

Paying for this up front will be painful, but the cost of not doing it will be more so.

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.