May 12, 2011
Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.
The results of the HPTN Study 052 -- which randomized 1,763 serodiscordant couples to early vs delayed ART to evaluate whether this reduced the risk of HIV transmission -- have just been released:
Findings from the study were reviewed by an independent Data and Safety Monitoring Board (DSMB) ... The DSMB concluded that initiation of ART by HIV-infected individuals substantially protected their HIV uninfected sexual partners from acquiring HIV infection, with a 96 percent reduction in risk of HIV transmission ... Among the 877 couples in the delayed ART group, 27 HIV transmissions occurred. This was in contrast to only one (1) transmission that occurred in the immediate ART group. This difference was highly statistically significant.
Full details from the study are of course not yet available, but here are some reasons why the results, if not surprising, are so important, and why this is a huge win for earlier antiretroviral therapy:
We of course await information on adverse effects, quality of life, resistance, and cost, but it's hard to imagine that any of these factors would be of sufficient severity to negate the obvious personal and public health benefits of early ART. In fact, I'll go out on a limb and predict that they won't even come close.
And I'll also express the view that this result is far more important than the PrEP studies, since it's always made way more sense to me to treat the person with HIV, not the other way around. PrEP may have a small role in reducing the spread of HIV -- especially in certain very high-risk individuals -- but is unlikely ever to be widely adopted.
So treatment is prevention. Now we just have to figure out how to pay for it.
Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.
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