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HIV Study Named Year's Best

Science taps a clinical trial that showed the benefits of antiretroviral treatment in HIV patients as 2011's breakthrough of the year.

By | December 23, 2011

Scanning electron micrograph of HIV-1 budding (in green) from cultured lymphocyte WIKIMEDIA COMMONS, CDC-C. GOLDSMITH

A long-term study that found a drastic reduction in HIV transmission rates when patients received early treatment with antiretroviral drugs rose to the top of Science's list of the year's best scientific breakthroughs. The study, published in an August issue of the New England Journal of Medicine, found that HIV-positive people are 96 percent less likely to transmit the virus to their heterosexual partners when they were treated with antiretroviral drugs early in the course of their infection.

Out of nearly 1,800 participating couples from across the world where one partner was HIV-positive and the other HIV-negative, 28 people became newly infected with the virus in the 4 years since the trial began. Only one of those new infections occurred in the group of couples in which the HIV-positive partner was treated with antiretroviral drugs immediately after the disease was diagnosed. In the other group, treatment was started only after the patients' CD4 cell counts fell below 250.

Antiretroviral drugs are known to lower the viral load in the blood and in genital secretions, and researchers had suspected that treatment with the drugs prevented the spread of the disease. But this study is the first to confirm the effect in a large trial. The clinical trial was started in 2007 and was slated to run through 2015, but was stopped earlier this year when an independent monitoring board recommended that all of the study participants receive antiretroviral treatment immediately because their benefit was so markedly beneficial.

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Avatar of: Brian Hanley

Brian Hanley

Posts: 66

December 23, 2011

Unfortunately, this isn't terribly significant because the side effects of these drugs are too unpleasant. Educated HIV patients have trouble with compliance because they make them feel bad, and they are as motivated as anybody can be. Nausea, vomiting, diarrhea, heart disease, fatigue, rash, dry skin, adipose deposition in the belly and between the shoulders, etc.

The demographics that support the transmission of HIV mostly don't know they are. Those demographics are also primarily young adults who like to party, like to feel good, have a high need to be sexually attractive, and are pretty unconcerned about long-term consequences.

Thus, regardless of how hard this strategy is pushed, it will have no significant impact on HIV rates. Even if every single person diagnosed with HIV was 100% compliant, an 80%+ non-diagnosis rate will ensure there will be no effect.

Further, HIV is probably like other disease transmission patterns. Superspreaders account for the majority of infectious disease transmissions, even in airborne epidemics like SARS. (See Lloyd-Smith et al. Nature. 2005)

I do, however, think that a very strong public good should come from a push toward prophylactic use of anti-retroviral drugs. I am aware that far too many physicians (many who definitely should know better) do not prescribe HAART therapy until CD8 cell counts have fallen to a dangerous level. There have been clashes between physicians with patients enrolled in studies and research personnel who felt morally obligated to advise enrollees to obtain HAART therapy.

Any change that gets HIV patients onto HAART therapy earlier is doubtless to the good. For those few who choose to start anti-retroviral therapy due to lifestyle choices, for them it will be a good thing. But don't expect this to make a big public health difference.

Avatar of:

Posts: 0

December 23, 2011

Unfortunately, this isn't terribly significant because the side effects of these drugs are too unpleasant. Educated HIV patients have trouble with compliance because they make them feel bad, and they are as motivated as anybody can be. Nausea, vomiting, diarrhea, heart disease, fatigue, rash, dry skin, adipose deposition in the belly and between the shoulders, etc.

The demographics that support the transmission of HIV mostly don't know they are. Those demographics are also primarily young adults who like to party, like to feel good, have a high need to be sexually attractive, and are pretty unconcerned about long-term consequences.

Thus, regardless of how hard this strategy is pushed, it will have no significant impact on HIV rates. Even if every single person diagnosed with HIV was 100% compliant, an 80%+ non-diagnosis rate will ensure there will be no effect.

Further, HIV is probably like other disease transmission patterns. Superspreaders account for the majority of infectious disease transmissions, even in airborne epidemics like SARS. (See Lloyd-Smith et al. Nature. 2005)

I do, however, think that a very strong public good should come from a push toward prophylactic use of anti-retroviral drugs. I am aware that far too many physicians (many who definitely should know better) do not prescribe HAART therapy until CD8 cell counts have fallen to a dangerous level. There have been clashes between physicians with patients enrolled in studies and research personnel who felt morally obligated to advise enrollees to obtain HAART therapy.

Any change that gets HIV patients onto HAART therapy earlier is doubtless to the good. For those few who choose to start anti-retroviral therapy due to lifestyle choices, for them it will be a good thing. But don't expect this to make a big public health difference.

Avatar of:

Posts: 0

December 23, 2011

Unfortunately, this isn't terribly significant because the side effects of these drugs are too unpleasant. Educated HIV patients have trouble with compliance because they make them feel bad, and they are as motivated as anybody can be. Nausea, vomiting, diarrhea, heart disease, fatigue, rash, dry skin, adipose deposition in the belly and between the shoulders, etc.

The demographics that support the transmission of HIV mostly don't know they are. Those demographics are also primarily young adults who like to party, like to feel good, have a high need to be sexually attractive, and are pretty unconcerned about long-term consequences.

Thus, regardless of how hard this strategy is pushed, it will have no significant impact on HIV rates. Even if every single person diagnosed with HIV was 100% compliant, an 80%+ non-diagnosis rate will ensure there will be no effect.

Further, HIV is probably like other disease transmission patterns. Superspreaders account for the majority of infectious disease transmissions, even in airborne epidemics like SARS. (See Lloyd-Smith et al. Nature. 2005)

I do, however, think that a very strong public good should come from a push toward prophylactic use of anti-retroviral drugs. I am aware that far too many physicians (many who definitely should know better) do not prescribe HAART therapy until CD8 cell counts have fallen to a dangerous level. There have been clashes between physicians with patients enrolled in studies and research personnel who felt morally obligated to advise enrollees to obtain HAART therapy.

Any change that gets HIV patients onto HAART therapy earlier is doubtless to the good. For those few who choose to start anti-retroviral therapy due to lifestyle choices, for them it will be a good thing. But don't expect this to make a big public health difference.

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Mettler Toledo
Mettler Toledo
Life Technologies