Early HIV Treatment Can Reduce Transmission Risk by 96%, Study Results Show

[John2038]

Anti-HIV drugs prove highly effective in preventing transmission of virus

Results from a multicountry clinical trial, sponsored by the National Institute for Allergy and Infectious Diseases (NIAID), show that HIV-positive people who take combination antiretroviral therapy (ART) can reduce the risk of transmitting the virus to their HIV-negative partners by 96 percent, U.S. researchers announced on Thursday in what is being hailed as a breakthrough in HIV prevention.


http://www.latimes.com/health/la-he-aids-prevention-20110513,0,705918.story

[Hellraiser]

This is what we've been saying for a while now, eh?

[Rev. Moon]

This is what we've been saying for a while now, eh?

Yeah, the funny thing is that I saw this as breaking news on Bloomberg (excellent news for the pharmaceutical companies; more heads taking meds as soon as they get diagnosed), Yahoo, CNN, and ScienceDaily. You'd think they had discovered something truly groundbreaking.

[mecch]

Heard it on NY news radio today, like it was breaking news, huge discovery.  Hmmm.  America is so inward looking.  Anyway, it IS good news to get out to the public!

[elf]

This as well as the consistent condom use seems to make obligatory disclosure less obligatory in places where non-disclosure is not required (most of Europe).

I haven slept with anyone for 3 years (since my diagnosis) but I know that my disclosure would make me automatically an HIV activist which I am not sure I am ready to be yet.

In a small country, with few HIV ''cases'', HIV disclosure would spread with the speed of light, all across the country.

I would have no problems with disclosing if I lived in a large country (like US or Mexico or Argentina or France or Spain).

[mecch]

in places where non-disclosure is not required (most of Europe).

Huh?  Could you say what you mean without a double negative, please.

[elf]

Well, here, disclosure is not required for safe sex.
But, ''morally'' one is expected to disclose. This is what HIV negative people expect.
They are not it my position.

(When I was HIV-, I never expected anyone to disclose.
I didn't get the virus because of the other person's non-disclosure, but because of the fact that
a condom was not used).

Even for medical reasons, disclosure seems a big no-no to me.
  Most people who disclose their status are rejected by medical ''professionals'' and these ''stories''
end up in newspapers.  
My ID doctor told me I should be happy that my family doctor ''accepted'' me, because it seems a rare thing here.  

[LM]

In a perfect world with no prejudice, early disclosure would be ideal. Obligatory disclosure is ridiculous, it's a major human right violation, in my opinion, and it's shocking that exists in developed countries. Where I live, there's no such thing, luckily. I believe no one has this moral duty of disclosing when meeting, just making sure to have safe sex and protect the other person. Nothing more, nothing less. I do believe, though, that if you are entering a relationship, you should tell. But that should usually take a few months. They should know what they are getting into as you get involved.

[mecch]

Well, here, disclosure is not required for safe sex.
But, ''morally'' one is expected to disclose. This is what HIV negative people expect.
They are not it my position.

Ah ok.  First on the word confusion.  So in fact there is no "obligatory disclosure" in your country.  You meant the moral obligation.

Otherwise, sorry to hear how awful it is for HIV+ there.

[John2038]

wondering restricted to the swiss statement conditions, it will confirm it.

In particular, no others STDs, fully adherent and UD since 6 months at least.
The Swiss statement was based on a large set of existing studies.

Nothing new for most poz, but for the general public, one can understand that this is a real breakthrough.
As mecch said, it IS good news to get out to the public!

[Ann]

The Swiss statement was based on heterosexual couples and unprotected vaginal intercourse. Unfortunately, it did not look at unprotected anal intercourse, which tops the scale as the most risky activity where hiv is concerned, whether it is between two men or a man and a woman.

To say that the Swiss statement says the same thing about unprotected anal intercourse as it says about unprotected vaginal is foolhardy at best and downright dangerous at worst.

There's another member here, I think it's Matt the Newt, who has often bemoaned the lack of similar studies looking at unprotected anal intercourse under the same conditions as the studies the Swiss statement looked at and I agree with him. We need these studies before we can assume the results will be the same or similar.

As far as I can tell, the studies were done with heterosexual couples because they wanted to look at the safety for procreation purposes. It doesn't take much of a stretch of the imagination to think that there have been no studies looking at anal intercourse because procreation doesn't come into it. And that's totally unfair and discriminatory if you ask me.

While I agree that someone with an undetectable viral load is going to be much less likely to pass their virus on, I think these news reports are very misleading and dangerous. Condoms still need to be used. Even when condoms are not being used for procreation purposes, it is usually recommended that the woman monitors her fertility cycle and condoms are only not used during her most fertile times. If it is the man who is positive, it is also often recommended that the woman takes PreP.

So many details are being left out of these reports.

And who is going to fund all this? We're having a difficult time as it is getting meds to people who have a clinical need for them. If politicians don't give a shit about people who are already hiv positive and in dire need of meds, then why is there any reason to think they're going to give a shit about people who may be at risk for infection? They don't give a shit either way, if you ask me.

[John2038]

restrict to the swiss statement criteria indeed, hetero only.
The present study includes 3% of MSM and i dont see the point mixing both but instead providing data for both categories.

Now i dont know what is the difference between both categories if hetero are having anal sex as well, as the man can be either the poz or the neg

when the swiss statement was made public, it has raised a lot of controversy.
I see here an opportunity to conclude.

Sorry Ann for my innaccurate comment and thanks for clarifying

[Ann]

Yes, straight couples also engage in anal, but the studies the Swiss statement looked at did not include anal activities, only vaginal as they were looking at it from a procreation point of view. Before these studies came out, the very expensive procedure of sperm-washing was seen as the only way to safely conceive for poz/neg straight couples. Either that or adoption.

The big difference between vaginal and anal intercourse is a matter of anatomy. The vaginal walls are quite thick in comparison to the walls of the anus/rectum and are far less prone to damage.

With the rectum being part of the digestive system, there are more of the cell types present that hiv can infect (we all know how the digestive tract - and the lymph system surrounding it - is one of the bigger hiv reservoirs) and this plays into it as well.

There are so many factors to take into account and the simplistic news reports that come out never seem to go into the details - and the details are very important. 

[sfpvguy41]

Gates Foundation study reported this last year. http://www.hivandhepatitis.com/recent/2010/0604_2010_b.html   

I dont think anyone is suggesting treatment means no condoms so much as it should be treatment and condoms.  I got hiv in some unknown way, no obvious safer sex accidents, and used condoms.  It makes me wonder if no treatment plus condoms puts you at greater risk than treatment and no condoms anyway?

No matter, there is no longer any doubt a sexually active person should be treated right away. And our US government is cutting ADAP funds and refuses to buy generics....some kind of public health policy huh??

[Cosmicdancer]

A study by Columbia University's School of Public Health found that expanding treatment to discordant couples could have a big impact on the global HIV epidemic.  This article doesn't say what the projected decline in new cases could be, but as one would expect, researchers believe it could be more effective in some countries than others. 

http://www.sciencedaily.com/releases/2011/10/111018121840.htm

Expanding HIV Treatment for Discordant Couples Could
Significantly Reduce Global HIV Epidemic

ScienceDaily (Oct. 18, 2011) — A new study uses a mathematical model to predict the potential impact of expanding treatment to discordant couples on controlling the global HIV epidemic-- in these couples one partner has HIV infection and the other does not. The research conducted at ICAP at Columbia University's Mailman School of Public Health and the Semel Institute of Neuroscience and Human Behavior at University of California in Los Angeles (UCLA) is the first to predict the effect of the expansion of such treatment in couples on the HIV epidemic in certain African countries.

In "Modeling the Impact on the HIV Epidemic of Treating Discordant Couples with Antiretrovirals to Prevent Transmission," authors Wafaa El-Sadr, MD, MPH, MPA, director of ICAP at the Mailman School, and Brian Coburn, PhD and Sally Blower, PhD at UCLA's Center for Biomedical Modeling, designed a mathematical model that was able to determine the number of infections prevented as a result of treating discordant couples. They used their model to make predictions for Ghana, Lesotho, Malawi and Rwanda. Full study findings were e-published on October 11, 2011 in the Journal, AIDS.

The authors use data for their modeling from a recent clinical study, HPTN 052, that showed that treatment of the HIV infected individuals in couples where the other partner was not HIV infected was successful in reducing transmission by 96 percent. "The findings from the modeling study provide insights into what to expect at a country level of expanding such a prevention strategy," noted Dr. El-Sadr, "Getting information to countries with regards to what they can expect from scale up of treatment for discordant couples on their epidemics is critical to their decision making."

"The most important aspect of our study is that by using a model to scale up the results of a clinical trial, we were able to predict the effectiveness of the intervention in controlling HIV epidemics," said Dr. Coburn. "It was very exciting to find that this couples-based intervention could be extremely effective." Dr. Blower added, "Our findings are very important as they show the intervention may be very successful in certain countries but not in others. This means we can use our model to identify which specific countries should begin to rollout this intervention."

The authors also demonstrate a practical approach for identifying countries where the expansion of HIV treatment in discordant couples is likely to have a strong effect in terms of preventing further spread of HIV. Such information is of great value as policy makers and public health leaders tackle tough decision in terms of determining their HIV control programs.