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Treatment is prevention: HPTN 052 study shows 96% reduction in transmission when HIV-positive partner starts treatment early
Keith Alcorn, 2011-07-18 22:30:00
Results from a trial showing that antiretroviral treatment prevents HIV from being passed onto uninfected partners received a standing ovation today at the Sixth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Rome.
HPTN 052 showed that early treatment – started at a CD4 count between 350 and 550 cells/mm3 – reduced the risk of HIV transmission to an uninfected partner – by at least 96%. Almost all the study participants were heterosexual couples.
The study lends some support to advice given three years ago in the Swiss statement, a document issued by Swiss doctors which stated that, for heterosexual couples where the HIV-positive partner had an undetectable viral load on stable treatment (and no sexually transmitted infections) the risk of HIV transmission through vaginal intercourse was negligible.
But Professor Myron Cohen of the University of North Carolina, who led the study, urged caution in interpreting the results, reminding the audience that the transmission study had followed patients for a median of 1.7 years.
Nevertheless, he said, “these are important results to give to a serodiscordant couple.”
The HPTN 052 study recruited 1763 couples in Malawi, Zimbabwe, Botswana, Kenya, South Africa, Brazil, Thailand, the US and India. The trial recruited serodiscordant couples – one HIV-positive, one HIV-negative – in which the HIV-positive partner had a CD4 cell count between 350 and 550 cells/mm3, and was thus ineligible for treatment.
The HIV-positive participants were randomised either to start treatment immediately, or to defer treatment until their CD4 counts fell into the range 250 to 200, the threshold for starting treatment in national guidelines at the time the study began recruiting.
The overall gender balance in the trial was even, but the HIV-positive participants were significantly more likely to be women in the Africa region.
Approximately 95% of the couples were married, and 6% reported unprotected intercourse in the previous month at baseline.
Of note, just over one-quarter of HIV-positive individuals reported no sexual activity at baseline, and there is some indication that sexual activity actually declined at some points during the follow-up period in both the immediate- and the deferred-treatment arms.
However, condom use was high, reported by 94% of HIV-positive individuals at baseline, and there was no evidence of a decline in self-reported condom use as the study went on.
Source:1
