Alex Blaze

HIV Treatment Is a Form of HIV Prevention

Filed By Alex Blaze | May 13, 2011 1:00 PM | comments

Filed in: Living

As more and more states look into cutting HIV treatment assistance stavudine.jpgprograms to balance their budgets, perhaps here's something for them to consider:

HIV carriers who start treatment before the virus can ravage their immune systems are 96 per cent less likely to infect their partner, a landmark new study has found.

The findings are a breakthrough in combating the spread of HIV. In theory, if every person carrying the virus was treated at the earliest opportunity, the spread of Aids could almost be stopped in its tracks.

Dr Anthony Fauci, director of the U.S.-based National Institute of Allergy and Infectious Diseases (NIAID), which funded the study, said: 'These findings strongly indicate that treating an individual sooner rather than later can reduce the risk of HIV transmission to a sex partner.'

Current medical guidelines suggest starting treatment when a sufferer's CD4 T-cell count - a measure of the strength of the immune system - drops to between 350 to 500 cells per cubic millimetre of blood.

Is this the sort of news that will get the US and other countries to take HIV testing and treatment more seriously? It's not just about the person who needs the medication, as it's often represented, who can be pushed aside and told that they need to pay for their own treatment if they want the privilege of continuing to live. This and other studies have put treatment and testing front and center when it comes to prevention. img src

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Seeing this make the rounds has been so encouraging, considering the recent release that an effective PreP study for MSM did not show anywhere near the same effectiveness for WSM.

While not technically PreP, the use of ARVs as a preventative measure showing this much effectiveness is really a morale booster.

The re:solve AIDS project is raising money to get a promising AIDS vaccine through human testing so that it can be produced and made available to everyone who needs it.

Thanks for the highlight- it's beyond common sense to further explore this.
Probably why it won't happen.

The problem with starting the treatment as soon as possible is that it actually decreases subject longevity. In much the same way as a bacterial infection develops antibiotic resistance if not completely destroyed, HIV will evolve drug resistance after treatment has been going for some time.

At the very least, they shouldn't start it during the acute phase. The drugs will be the only thing killing them off and resistance will develop very, very quickly.

(sorry for the science-ese--I just finished a project on this very topic)

Bob Roehr | May 14, 2011 10:51 AM

Sorry to be brutally honest in this response but if this is what you learned on your "project" then you deserve a failing grade on it.

If the drug regimen is powerful enough AND the patient takes them as directed without skipping doses, then there is no reason for viral resistance to develop. That includes initiating treatment during actue infection. In fact, starting treatment during acute infection likely is the only time one can affect the viral setpoint and the long term course of disease.

Actually, in my work, I noticed that there was by and large clinical equipoise regarding whether to start treatment early or start treatment later, for all the reasons above.

Medical consensus was mixed out of fear of developing drug resistance, leaving a patient with fewer options down the road. And to be fair, adherence to medication is a tough challenge, and the last thing I feel you should assume to ensure success of your methodology. With a lack of stringent adherence, the risk is higher that resistance will be a factor. And also consider that an individual treated at acute stage is less likely to be habitually familiar with strict medication adherence due to numerous factors such as age or medical history.

However, there was growing evidence that early ARV therapy demonstrated health benefits and cut transmission. Likewise, drug options have increased and the negative effects of medications have also changed compared to the decades previous.

I think this study puts a strong argument in the early treatment camp.

Bob Roehr | May 14, 2011 10:39 PM

The equipoise you note is largely the product of a loose definition of "early" when it comes to acute infection. Most studies have defined "early" as within 6 months of the point of infection, and have seen little benefit from this in terms of viral setpoint etc.

However, if one can begin treatment while the patient is experiencing flu-like symptoms, before antibodies develop that would be detected with the standard ELISA test, then it does appear possible to affect the viral setpoint by initiating therapy. However, it is difficult to identify an acute HIV infection at such an early time point; generally only when the patient is aware of both a potential exposure and the symptoms of acute infection.

Therapies today are much more potent at suppressing the virus, more forgiving of a missed dose or two, easier to take, and more tolerable in terms of side effects, all of which contribute to greater long term control of the virus and less risk of the emergence of resistance.

Also, there is a growing body of evidence that the inflammation associated with viral replication has long term consequences of accelerated aging, cardiovascular disease, diabetes, etc.

There is a review paper on acute HIV infection that will be out in a few days in NEJM.

Really informative! Thanks, Bob!