Hope for more options in couples where one partner is HIV positive

November 15, 2011

In sub-Saharan Africa, couples in long-term relationships where one partner is HIV-positive and the other is HIV-negative (HIV serodiscordant couples) could benefit from anti-AIDS drugs (antiretroviral therapy) given either as treatment or as a prevention measure (prophylaxis) to reduce the risk of HIV transmission. These findings, from a modelling study led by Timothy Hallett from Imperial College London and published in this week's PLoS Medicine, also show that this strategy could be cost-effective.

In sub-Saharan Africa, where most new HIV infections occur and condom use is often low, 10% of stable partnerships are serodiscordant. The authors used detailed information and specific data from South Africa to construct a model to simulate HIV infection and disease progression among hypothetical HIV serodiscordant couples in stable heterosexual relationships. The authors used the model to compare the impact on HIV transmission, survival and quality of life and the cost-effectiveness of different prophylaxis strategies.

To keep couples alive without the HIV-uninfected partner becoming infected, the authors found that it could be at least as cost-effective to provide prophylaxis to the uninfected partner as to initiate antiretroviral therapy earlier than current guidelines in the infected partner. Specifically, the most cost-effective strategy for couples could be to use prophylaxis in the uninfected partner prior to starting antiretroviral therapy in the infected partner.

These findings suggest that prophylaxis may become a valuable addition, in some settings, to existing approaches for HIV prevention such as condom promotion, male circumcision programs and anti-retroviral treatment.

The authors say: "We hope [these findings] might inform the choices that will be available for HIV prevention in couples. We note, however, that it is important that many other considerations besides cost effectiveness should inform decision-making for HIV treatment initiation and provision of [prophylaxis] in couples, including equitable access and the preferences of the couples themselves."
-end-
Funding: The authors thank The Wellcome Trust (fellowship to TBH), and the Bill & Melinda Gates Foundation (grant support to all authors), the US National Institutes of Health (1R01MH095507-01), and the Qatar National Research Fund (NPRP 08-068-3-024). No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: TBH has received consultancy fees from the Bill & Melinda Gates Foundation for work not directly related to the present work. GPG has in the past been a consultant in the field of Human Papilloma Virus research to Glaxo SmithKline and Merck, and has been a consultant in the field of stem cell transplantation to ViroPharma, but has no conflicts of interest in the HIV field. All other authors have declared that no competing interests exist.

Citation: Hallett TB, Baeten JM, Heffron R, Barnabas R, de Bruyn G, et al. (2011) Optimal Uses of Antiretrovirals for Prevention in HIV-1 Serodiscordant Heterosexual Couples in South Africa: A Modelling Study. PLoS Med 8(11): e1001123. doi:10.1371/journal.pmed.1001123

CONTACT:

Timothy Hallett
Infectious Disease Epidemiology
Imperial College London
Norfolk Place
London W2 1PG
United Kingdom
44-2075941150
timothy.hallett@imperial.ac.uk

PLOS

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.