May 14, 2011

May 14, 2011
Drugs Radically Reduce Transmission of Virus

Welcome to another day in my life. Today is Saturday and I hope you had a safe, great week after surviving Friday the 13th! It is another busy weekend for Dab the AIDS Bear with the AIDS Walk NYC this Sunday.

A new report has come out about the effectiveness of HIV medications. Drugs radically reduce transmission of virus A new study shows a 96% reduction in transmission of the AIDS virus to spouses and partners when HIV positive people take anti-AIDS drugs. The drugs were unexpectedly effective.

In what is being hailed as a landmark breakthrough in HIV prevention, a new study has shown that giving anti-AIDS drugs to HIV positive people can reduce the transmission of the virus to spouses and partners by 96%, U.S. researchers said Thursday.

Though some uncontrolled studies of populations had previously suggested that treatment of patients with antiretroviral drugs could slow transmission of the virus, the new results announced by the National Institute of Allergy and Infectious Diseases represent the first large clinical trial to confirm those suggestions and they showed that the drugs are unexpectedly effective.

In fact, the results of the study of nearly 1,800 couples in the United States and southern Africa were so dramatic that the study's sponsors decided to terminate it prematurely four years before its scheduled completion in 2015.

The study shows that not only does early treatment of HIV infections benefit the patient's own health, but also there is clearly a benefit of a profound decrease in the probability of transmission to his or her own partner.

Antiretroviral treatment can definitely decrease rates of transmission, and we can get this disease under control. This is scientific proof that this is true.

The clinical trial, begun in April 2005, was conducted at 13 sites in nine countries. Although the United States was one of the countries, there were only two couples who participated here, presumably because few people wanted to run the risk of deferring treatment.

The trial enrolled 1,763 couples in which only one partner was infected: Those infected included 890 men and 873 women; 97% of the couples were heterosexual. All the infected patients had CD4 counts a measure of the severity of the infection óbetween 350 and 550 at the beginning of the study. U.S. treatment guidelines now call for antiretroviral treatment to begin when CD4 counts fall below 500, but international guidelines typically require a wait until counts drop below 350.

For half the couples selected randomly the infected member began receiving a cocktail of anti-AIDS drugs immediately, and half had treatment deferred until the patient's CD4 count fell below 350 or he or she developed an AIDS defining complication, such as pneumocystis pneumonia. All the subjects received counseling on safe sex, free condoms and treatment for any sexually transmitted diseases that occurred during the study.

When the monitoring committee examined the interim results last month, they found 39 new HIV infections. Twenty eight of the infections clearly came from the person's partner based on genetic analysis of the virus, seven were thought to have arisen from other sources, and four probably came from other sources but the researchers were not sure yet.

Among the 28 partners who developed new infections that clearly seemed to come from their partner, 27 were in the group where treatment with antiretroviral drugs was deferred.

The preliminary results also showed some benefit for the patients themselves. The team observed 17 cases of disseminated tuberculosis (TB that has spread beyond the lungs) in the deferred treatment group and only three in the immediate treatment group. TB is a leading killer of HIV positive people.

There were 23 deaths in the study, 10 in the immediate treatment arm and 13 in the other arm. The difference was not statistically significant, and the researchers have not yet analyzed the causes.

"This is amazing news. Prevention can be a reality. The science is strong so strong that we must use it.

The $73 million study was funded by NIAID. The 11 different drugs used by participants were provided free of charge by the companies that make them. The cost of the drugs in the developing countries would normally be a few hundred dollars per year.

All patients in the study will now receive the drugs for at least another year as Cohen and his colleagues monitor them to determine whether the findings are durable.

So are there any down sides to starting people on medications as soon as they are diagnosed? Of course there are but I will save that discussion for the blog tomorrow.

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab