Early HIV Drug Therapy Protects Sex Partners From
THURSDAY, May 12 (HealthDay News) -- People with HIV can reduce
the risk of infecting their sex partners by more than 90 percent if
they start treatment with antiretroviral drugs when their immune
system is still relatively healthy, researchers announced
The study, which included 1,763 mostly heterosexual couples from
nine countries, was supposed to last until 2015, but the results
were released early because of the significance of the findings.
The research confirmed a belief held by many scientists and
physicians -- that starting drug therapy early can help to limit
rates of transmission of the virus that causes AIDS.
"We set out to prove that if you took earlier therapy you could benefit your own health and you could prevent the transmission of HIV," said lead researcher Dr. Myron Cohen, director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill.
"Both of those hypotheses were realized," he said.
The study, which started in 2005, randomly assigned the couples
to two treatment groups: In the first group the HIV-infected
individual began taking a combination of three antiretroviral drugs
immediately. In the second group, the HIV-positive person delayed
drug therapy until their CD4 T-cell count -- a blood test that
measures immune system health -- either dropped below 250 or an
AIDS-related illness (such as pneumocystis pneumonia) set in.
Both groups also received HIV care, which included counseling on
safe sex, free condoms, treatment for sexually transmitted
infections, regular HIV testing and evaluation, and treatment for
any HIV-related complications.
The trial was conducted at 13 sites in nine countries including
the United States, Botswana, Brazil, India, Kenya, Malawi, South
Africa, Thailand and Zimbabwe.
In looking over the preliminary findings, the data and safety
monitoring board shepherding the study identified 39 new cases of
HIV among the previously uninfected partners. In 28 of these cases,
genetic analysis confirmed that one partner had infected the
Of these 28 infections, 27 -- or 96 percent -- occurred among
couples in which the HIV-infected partner did not start
antiretroviral therapy immediately.
Cohen cautioned that the findings don't apply to all
HIV-positive people. "Our couples had big advantages," he said. "We
enrolled couples who probably have a low overall transmission [HIV]
rate," he said.
The researchers also made sure that the patients were taking
their antiretroviral medications. And, the medications were
carefully selected. "The drugs are important," Cohen said. "We
didn't use any combination possible -- we used ones we thought
would sterilize the genital tract," he said.
Commenting on the study, Dr. Alexis Powell, an assistant
professor of infectious diseases at the University of Miami Miller
School of Medicine, said that "it's nice to finally have
evidence-based information that clearly shows that earlier
treatment with antiretrovirals can benefit the individual who is
HIV-positive, but also protects sexual partners who are
Most doctors would like to treat HIV patients sooner, Powell
said. "We clearly understand that patients benefit with earlier
treatment," she said. "And this is another reason to start
Powell said she'd like to put HIV patients on antiretrovirals as
soon as they are diagnosed, but there are barriers. They include
criteria for treatment set by insurance companies and lack of
funding to treat those without insurance, she said.
"When you start talking about the dollars and cents of everyday clinical practice, that's when we are really going to see what we are going to be allowed to do," Powell said.
Another barrier is convincing some HIV-positive people to take
the drugs. Some are reluctant to start taking medications that they
will have to take for the rest of their lives, while others are
wary of side effects. Some people think the drugs make you sicker
than the virus. And still others distrust the medical system to act
in their best interest, Powell said.
She cautioned that the study findings do not mean that people
can stop practicing safe sex. Men, especially, need to use a condom
to protect themselves or their partners, Powell said.
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