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by Emily Bridges, Director of Public Information Services
A breakthrough study has confirmed what researchers have long suspected: among heterosexual couples, taking HIV medications very soon after an HIV diagnosis significantly reduces the risk of transmitting HIV to a partner.
A study of 1,763 “serodiscordant” couples, where one partner is HIV positive and the other is HIV negative, found that beginning ARV (antiretroviral) therapy early led to a 96 percent reduction in HIV transmission. There were 28 total HIV infections among the couples in the study, and 27 occurred to couples where the HIV+ partner had not yet begun ARV.
Although the results may be unsurprising to many in public health, they could be a bombshell to the HIV prevention and treatment field. HIV attacks the body by killing off the immune system’s “t-cells” or “CD4 cells.” An HIV negative person has between 500-1200 CD4 cells (per ml of blood). When a person is diagnosed HIV positive, they do not necessarily begin taking ARVs immediately – only once their CD4 count drops below a certain number. Current World Health Organization guidelines recommend beginning treatment when the CD4 count drops below 350. This study is the first to demonstrate so decisively that earlier treatment prevents transmission so effectively.
But the patients in the study began treatment immediately, no matter how high their CD4 count was – and it protected their partners from acquiring HIV.
What does this mean for HIV treatment guidelines?
UNAIDs has noted that while the science around a “test and treat” approach, in which everyone is routinely tested and begins treatment immediately after a positive diagnosis, is strong, but that real-world implementation must be undertaken very thoughtfully and comes with the risk of expending more on treatment without saving more lives.
In the US, the Centers for Disease Control and Prevention (CDC) meets the announcement with measured enthusiasm, observing:
While today's announcement provides cause for optimism that this approach may help reduce new HIV infections overall in the United States and around the world, the degree of impact at a population level will depend on many factors, including the real-world feasibility of scaling up intensive testing and care services in a broad range of settings, as well as the ability for individuals to maintain high levels of drug adherence over time.
However, HIV-positive people cannot assume they are not infectious simply because they are already on treatment medications. It is critical that individuals maintain close contact with their healthcare providers, in order to monitor viral load, and to maintain consistent treatment and care services over time.
Indeed, given that lack of access to treatment is one of the major disparities in the HIV epidemic, it follows that attaining universal testing and treatment will be a difficult goal to achieve – especially in an era where state legislators around the nation are denying low-income patients assistance for the AIDS drugs they need. Those budget cuts could come at the expense of millions of dollars in treatment - and thousands of lives.
Advocates for Youth remains committed to ensuring early testing and treatment for all young people, in the United States and around the world. Forty percent of new HIV infections around the world are among young people under 25; in the United states, 50 young people under 30 acquire HIV every day. We need every tool in the toolbox to help these young people protect the health and lives of themselves and their partners. |
