Study shows that HIV transmission can be effectively reduced through protective antiretroviral therapy for serodiscordant couples

November 30, 2012

After the randomised controlled trial HPTN 052 showed in 2011 that ART treatment for the HIV-positive partner in a serodiscordant couple reduces sexual transmission of HIV, the World Health Organization (WHO) issued guidelines recommending that all HIV-positive partners in serodiscordant couples should be offered ART. However, until now, the real-world efficacy of this recommendation has never been tested.

A group of researchers led by Professor Yiming Shao, at the Chinese Center for Disease Control and Prevention in Beijing, examined data from China's national HIV and epidemiology and treatment databases on over 38000 serodiscordant couples. Of these, 24057 couples had received ART at the start of the study period, while 14805 had not. Couples were followed for up to nine years (2003 - 2011), with the results of biannual HIV tests recorded alongside other data, such as age, educational attainment, and how the HIV infection had been acquired.

The scientists found that the rate of HIV transmission to the uninfected partner in the group that had received treatment was significantly lower than in the group that received no treatment, with ART for the HIV-positive partner conveying an overall 26% relative reduction in the risk of HIV transmission, compared to those without treatment.

This is the first time that ART for serodiscordant couples has been shown to have an effect on reducing HIV transmission rates in a real-world setting, vindicating the results of earlier trials, and demonstrating that this approach to reducing HIV transmission is feasible and effective in practice. However, the authors found that the protective effect of ART seemed to only last for one year, with transmission rates becoming comparable after the first year for both treated and untreated couples. They also noticed that the treatment as prevention was not effective when HIV-positive partners were injecting drugs or had very high CD4 cell counts [1].

According to Professor Shao, "These results substantiate the previous evidence from smaller observational studies and one randomised clinical trial that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale and in a developing country context. The durability and generalisability of such protection, however, should take account of the patient status. It's possible that increasing rates of resistance to treatment in patients with high CD4 level, or decreasing adherence to treatment in patients injecting drugs, are contributing to the reduction in the protective benefit of treatment over time, but this, and other possibilities, will need further investigation." [2]

Writing in a linked Comment, Professor Sten Vermund, at Vanderbilt University in Nashville, Tennessee, USA, describes the results as "encouraging", but adds that, "For further insights, we must rely on research that is still in progress. Can community, regional, national, and international expertise and resources be mobilised to offer testing to all at-risk people at least yearly, link all infected people to care, and offer antiretroviral therapy to a much higher proportion of infected people than receive it at present, alongside expanded combination prevention activities? Can we ultimately reverse the HIV pandemic with the treatment-as-prevention approach, by offering antiretroviral therapy at coverage far greater than has been achieved up to now? Answers to these questions depend on rigorous research into implementation and programme deployment, so that we can succeed in bringing programmes to scale."
-end-
NOTES TO EDITORS:

[1] CD4 cells are a type of white blood cell, and their levels can be used to monitor the progress of HIV in a patient. When a patient is infected, the virus enters CD4 cells, and then uses these cells to replicate. These copies then leave the CD4 cells, killing them in the process, which continues until eventually the number of CD4 cells drops so low that the immune system stops working.

[2] Quote direct from author and cannot be found in text of Article

Lancet

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.