HIV treatment: an incredible advance

We reported on a study in November about the marked efficacy of Gilead Sciences, Inc.’s HIV drug Truvada for protection against the transmission of HIV between male partners. Now a new trial carried out by researchers with the HIV Prevention Trials Network shows that such preventive anti-retroviral protocols dramatically reduce HIV transmission in heterosexual couples. The NIH-funded trial of nearly 1,800 couples — 97% of whom were heterosexual — with one HIV-positive partner showed that treatment with anti-retrovirals, such as Truvada or GlaxoSmithKline’s Combivir, upon diagnosis reduced transmission to uninfected partners by 96 percent; this was compared to a delayed course of treatment and receipt of condoms and counseling. The subjects were recruited from thirteen different countries in the trial called HTPN-052. Given the magnitude of the reduced transmission, the study was halted early in order to allow those in the control group to receive the therapy.

The World Health Organization currently recommends that doctors wait for a patient to develop AIDS-defining symptoms — which may indicate advanced illness — or experience a low immune cell count before prescribing anti-retrovirals in order to avoid subjecting them to the often unpleasant side effects of these drugs.

ACSH’s Dr. Josh Bloom — author of our Whatever Happened to AIDS? publication — thinks this is a remarkable story. “It’s astounding that with just two or three drugs — even though it took a long time to discover and develop them — we can now prevent HIV transmission to such an extent. I doubt anyone could have predicted this, especially if you recall the doomsday scenarios that dominated the news in the early 1990s. Some thought the world might end because of AIDS. Now we have a very tight grip on this awful disease.”

ACSH’s Dr. Gilbert Ross agrees and believes that this study could — and should — spark a paradigm shift in clinical practice. “Clearly, patients should now be treated as soon as HIV infection is confirmed.” According to the report, however, only about 36 percent of the 15 million people who need the anti-retroviral treatment in low- and middle-income countries are able to obtain it.